Saphenous vein harvest with SaphLITE system versus conventional technique: a prospective, randomized study.

BACKGROUND: Minimally invasive saphenous vein harvest (MIVH) techniques have been evaluated and reported with heterogeneous results. The aim of this study was to evaluate the efficacy of MIVH on the outcomes of postoperative leg wound healing and pain using the SaphLITE retractor system. METHODS: Two hundred twenty-five patients undergoing elective coronary artery bypass grafting surgery were randomized to receive either SaphLITE vein harvest (SVH) or conventional open vein harvest (OVH). RESULTS: There were no significant differences between the two groups in demographics, postoperative mortalities and major complications. For SVH group and OVH group, total leg wound length was 18.33 +/- 7.93 cm vs 46.10 +/- 15.63 cm (p < 0.001), and vein harvest time was 50.70 +/- 16.55 minutes vs 40.35 +/- 16.43 minutes (p < 0.001). In-hospital leg wound healing disturbance (LWHD) rate was 4.7% for SVH group and 1.7% for OVH group (p = 0.190). Delayed LWHD rate was 16.0% for SVH group and 39.5% for OVH group (p < 0.001). Combined, LWHD rate was 20.8% for SVH group and 41.2% for OVH group (p = 0.001). There was no significant difference in the worst postoperative leg wound pain or length of hospital stay between the 2 groups. Double-blinded histologic examinations revealed normal vascular structure in the harvested veins from both groups. CONCLUSIONS: Our study demonstrated that harvesting saphenous vein with SaphLITE retractor system is a good technique which is associated with reduced rate of delayed LWHD, preserved venous structural integrity, and acceptable harvest speed.

Coronary artery bypass surgery with heparin-coated perfusion circuits and low-dose heparinization.

OBJECTIVE: To evaluate the safety and efficacy of heparin-coated perfusion circuits with low-dose heparinization and centrifugal pumping compared with the standard method during coronary artery bypass grafting. DESIGN: Prospective, randomized, single-blind clinical trial. SETTING: A primary care institution. PATIENTS: Ninety patients who underwent first-time elective coronary artery bypass grafting were eligible for the study. After giving informed consent, they were randomly assigned to 1 of 3 groups (30/group). INTERVENTIONS: Perfusion on regular uncoated bypass equipment with a roller pump and full-dose heparinization (300 IU/kg bolus, activated clotting time [ACT] > 400 s) (group 1), on a heparin-coated oxygenator with a centrifugal pump and full-dose heparinization (group 2) and on fully heparin-coated bypass equipment with a centrifugal pump and low-dose heparinization (100 IU/kg bolus, ACT of 180-400 s) (group 3). Standard coronary artery bypass grafting was performed. OUTCOME MEASURES: Postoperative bleeding, transfusion requirements and clinical outcomes. RESULTS: There were no complications related to the study protocol. Study groups were similar in terms of postoperative bleeding, transfusion requirements and clinical outcomes. CONCLUSIONS: Heparin-coated cardiopulmonary bypass with low-dose heparinization and centrifugal pumping is a safe practice but showed no advantages over the use of regular uncoated bypass circuits for coronary bypass surgery.

Mycotic pulmonary artery aneurysm: an unusual complication of ventriculo-atrial shunt.

A 23-year-old man with a previous ventriculo-atrial shunt for a pinealoma developed a febrile illness and heart murmur. The condition was thought to be caused by subacute bacterial endocarditis. Further investigation, however, revealed a mycotic left pulmonary artery aneurysm, which was treated by means of a left pneumonectomy with cardiopulmonary bypass. Such an aneurysm represents yet another complication of ventriculo-atrial shunting for hydrocephalus.