Improved leg wound healing with endoscopic saphenous vein harvest in coronary artery bypass graft surgery: a prospective randomized study in Asian population.

OBJECTIVE: Conventional open saphenous vein harvest (OVH) for coronary artery bypass graft surgery is often associated with significant pain and morbidity. This study aims to determine whether endoscopic saphenous vein harvest (EVH) reduces leg wound morbidity and improves patient satisfaction as compared to OVH in Asian population. METHODS: Between March 2005 and June 2006, 120 patients who underwent isolated CABG were prospectively randomized into EVH (n = 60) and OVH (n = 60) groups. VirtuoSaph (Terumo Cardiovascular Corp., Ann Arbor, MI, USA) harvesting system was used for EVH. We analyzed leg wound complications (ASEPSIS score), postoperative pain, satisfaction, and clinical outcomes. Fisher's exact test and Mann-Whitney U test were used for categorical and continuous variables analysis respectively. RESULTS: Six patients in the EVH group required conversion to open technique. Both groups had matched demographic characteristics and risk factors. Mean numbers of grafts performed were 3.2 +/- 0.6 (EVH n = 54) and 3.0 +/- 0.7 (OVH n = 60) (p = 0.03). ASEPSIS scores at postoperation days three, seven, and 21 were significantly lower in the EVH group than the OVH group (p = 0.02, p = 0.002 and p = 0.01, respectively). Wound pain scores at postoperative days three, seven, and 21 were significantly lower in the EVH group (p = 0.000, p = 0.001 and p = 0.000 respectively). Wound numbness was found in 5.7% of the EVH group and 33.3% of the OVH group patients (p = 0.01). [Six patients required conversion to open technique.] There was one hospital mortality (OVH group) and major postoperative complications were not significantly different between the groups. CONCLUSION: EVH system is a safe and effective alternative to OVH with better wound healing, reduced postoperative pain, and wound numbness. However, the higher conversion rate to OVH in Asian patients requires further evaluation.

Biatrial pacing to prevent atrial fibrillation after coronary artery bypass.

Between October 1999 and December 2000, 52 patients (37 male) undergoing coronary artery bypass surgery were selected for overdrive biatrial pacing to determine its effectiveness in reducing atrial fibrillation. A pacing wire was attached to the right atrial appendage and another to the roof of the left atrium behind the aorta. The atria were paced continuously in AAI mode at a rate of 90 pulses per minute or 10 pulses above the underlying rate (maximum rate < 140/min) for 3 days. The endpoint was the onset of atrial fibrillation during hospital stay. Results were compared with those of a control group of 52 matched patients. There were no significant differences in the occurrence of atrial fibrillation (30% in the paced group vs. 25% in the control group), morbidity, or length of hospital stay. Continuous biatrial pacing after coronary bypass surgery was safe and well tolerated, however, it did not prevent or lower the incidence of atrial fibrillation.