Randomized study comparing the effect of CO2 insufflation on veins using two types of endoscopic and open vein harvesting.

Bhuvaneswari Bibleraaj, William Critchley, Janesh Nair, Ignacio Malagon, John Carey, James B Barnard, Paul Watermouth, Rajamiyer Venkateswaran, James Fildes, Ann Caress, Nizar Yonan

Research output: Contribution to journalArticle

3 Downloads (Pure)

Abstract

To assess whether the use of carbon dioxide (CO2) insufflation has any impact on integrity of long saphenous vein comparing two types of endoscopic vein harvesting (EVH) and traditional open vein harvesting. Methods: A total of 301 patients were prospectively randomized into three groups. Group 1 control arm of open vein harvesting (OVH)(n=101), Group 2 closed tunnel (CO2) EVH (CT-EVH) (n=100) and Group 3 open tunnel (CO2) EVH (OT-EVH) (n=100). Each group was assessed to determine the systemic level of Partial arterial CO2 (PaCO2), end tidal CO2 (EtCO2) and pH. Three blood samples were obtained at baseline, 10 minutes after start of EVH and 10 minutes after the vein was retrieved. Vein samples were taken immediately after vein harvesting without further surgical handling to measure the histological level of endothelial damage. A modified validated endothelial scoring system was used to compare the extent of endothelial stretching and detachment. Results: The level of end tidal CO2 was maintained in the OT-EVH and OVH groups but increased significantly in the CT-EVH group (p=0.451, p=0.385 and p<0.001). Interestingly, partial arterial CO2 also did not differ over time in the OT-EVH group (p=0.241) whereas PaCO2 reduced significantly over time in the OVH group (p=0.001). A profound increase in PaCO2 was observed in the CT-EVH group (p<0.001). Consistent with these patterns, only the CT-EVH group demonstrated a sudden drop in pH over time (p<0.001) whereas pH remained stable for both OT-EVH and OVH groups (p=0.105 and p=0.869 respectively). Endothelial integrity was better preserved in the OVH group compared to OT-EVH or CT-EVH groups (p=0.012) and was not affected by changes in CO2 or low pH. Significantly greater stretching of the endothelium was observed in the open tunnel endoscopic OT-EVH group compared to the other groups (p=0.003). Conclusions: This study demonstrated that the different vein harvesting techniques impact on endothelial integrity; however this does not appear to be related to the increase in systemic absorption of carbon dioxide or to the pressurised endoscopic tunnel. The open tunnel endoscopic harvesting technique vein had more endothelial stretching compared to the closed tunnel endoscopic technique; this may be due to manual dissection of the vein. Further research is required to evaluate the long term clinical outcome of these vein grafts.
Original languageEnglish
Pages (from-to)320-328
JournalInnovations:Technology and Techniques in Cardiothoracic and Vascular Surgery
Volume12
Issue number5
Early online date1 Sep 2017
DOIs
Publication statusE-pub ahead of print - 1 Sep 2017

Fingerprint

Insufflation
Veins
Carbon Dioxide
Saphenous Vein

Keywords

  • Coronary artery bypass surgery
  • Open vein harvesting
  • Closed tunnel endoscopic vein harvesting
  • Open tunnel endoscopic vein harvesting
  • endothelial integrity.

Cite this

Bibleraaj, Bhuvaneswari ; Critchley, William ; Nair, Janesh ; Malagon, Ignacio ; Carey, John ; Barnard, James B ; Watermouth, Paul ; Venkateswaran, Rajamiyer ; Fildes, James ; Caress, Ann ; Yonan, Nizar. / Randomized study comparing the effect of CO2 insufflation on veins using two types of endoscopic and open vein harvesting. In: Innovations:Technology and Techniques in Cardiothoracic and Vascular Surgery. 2017 ; Vol. 12, No. 5. pp. 320-328.
@article{9c63bc7424f644f2ad3bae0d6e45266d,
title = "Randomized study comparing the effect of CO2 insufflation on veins using two types of endoscopic and open vein harvesting.",
abstract = "To assess whether the use of carbon dioxide (CO2) insufflation has any impact on integrity of long saphenous vein comparing two types of endoscopic vein harvesting (EVH) and traditional open vein harvesting. Methods: A total of 301 patients were prospectively randomized into three groups. Group 1 control arm of open vein harvesting (OVH)(n=101), Group 2 closed tunnel (CO2) EVH (CT-EVH) (n=100) and Group 3 open tunnel (CO2) EVH (OT-EVH) (n=100). Each group was assessed to determine the systemic level of Partial arterial CO2 (PaCO2), end tidal CO2 (EtCO2) and pH. Three blood samples were obtained at baseline, 10 minutes after start of EVH and 10 minutes after the vein was retrieved. Vein samples were taken immediately after vein harvesting without further surgical handling to measure the histological level of endothelial damage. A modified validated endothelial scoring system was used to compare the extent of endothelial stretching and detachment. Results: The level of end tidal CO2 was maintained in the OT-EVH and OVH groups but increased significantly in the CT-EVH group (p=0.451, p=0.385 and p<0.001). Interestingly, partial arterial CO2 also did not differ over time in the OT-EVH group (p=0.241) whereas PaCO2 reduced significantly over time in the OVH group (p=0.001). A profound increase in PaCO2 was observed in the CT-EVH group (p<0.001). Consistent with these patterns, only the CT-EVH group demonstrated a sudden drop in pH over time (p<0.001) whereas pH remained stable for both OT-EVH and OVH groups (p=0.105 and p=0.869 respectively). Endothelial integrity was better preserved in the OVH group compared to OT-EVH or CT-EVH groups (p=0.012) and was not affected by changes in CO2 or low pH. Significantly greater stretching of the endothelium was observed in the open tunnel endoscopic OT-EVH group compared to the other groups (p=0.003). Conclusions: This study demonstrated that the different vein harvesting techniques impact on endothelial integrity; however this does not appear to be related to the increase in systemic absorption of carbon dioxide or to the pressurised endoscopic tunnel. The open tunnel endoscopic harvesting technique vein had more endothelial stretching compared to the closed tunnel endoscopic technique; this may be due to manual dissection of the vein. Further research is required to evaluate the long term clinical outcome of these vein grafts.",
keywords = "Coronary artery bypass surgery, Open vein harvesting, Closed tunnel endoscopic vein harvesting, Open tunnel endoscopic vein harvesting, endothelial integrity.",
author = "Bhuvaneswari Bibleraaj and William Critchley and Janesh Nair and Ignacio Malagon and John Carey and Barnard, {James B} and Paul Watermouth and Rajamiyer Venkateswaran and James Fildes and Ann Caress and Nizar Yonan",
year = "2017",
month = "9",
day = "1",
doi = "10.1097/IMI.0000000000000405",
language = "English",
volume = "12",
pages = "320--328",
journal = "Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery",
issn = "1556-9845",
publisher = "Lippincott Williams and Wilkins Ltd.",
number = "5",

}

Randomized study comparing the effect of CO2 insufflation on veins using two types of endoscopic and open vein harvesting. / Bibleraaj, Bhuvaneswari; Critchley, William; Nair, Janesh; Malagon, Ignacio; Carey, John; Barnard, James B; Watermouth, Paul; Venkateswaran, Rajamiyer; Fildes, James; Caress, Ann; Yonan, Nizar.

In: Innovations:Technology and Techniques in Cardiothoracic and Vascular Surgery, Vol. 12, No. 5, 01.09.2017, p. 320-328.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Randomized study comparing the effect of CO2 insufflation on veins using two types of endoscopic and open vein harvesting.

AU - Bibleraaj, Bhuvaneswari

AU - Critchley, William

AU - Nair, Janesh

AU - Malagon, Ignacio

AU - Carey, John

AU - Barnard, James B

AU - Watermouth, Paul

AU - Venkateswaran, Rajamiyer

AU - Fildes, James

AU - Caress, Ann

AU - Yonan, Nizar

PY - 2017/9/1

Y1 - 2017/9/1

N2 - To assess whether the use of carbon dioxide (CO2) insufflation has any impact on integrity of long saphenous vein comparing two types of endoscopic vein harvesting (EVH) and traditional open vein harvesting. Methods: A total of 301 patients were prospectively randomized into three groups. Group 1 control arm of open vein harvesting (OVH)(n=101), Group 2 closed tunnel (CO2) EVH (CT-EVH) (n=100) and Group 3 open tunnel (CO2) EVH (OT-EVH) (n=100). Each group was assessed to determine the systemic level of Partial arterial CO2 (PaCO2), end tidal CO2 (EtCO2) and pH. Three blood samples were obtained at baseline, 10 minutes after start of EVH and 10 minutes after the vein was retrieved. Vein samples were taken immediately after vein harvesting without further surgical handling to measure the histological level of endothelial damage. A modified validated endothelial scoring system was used to compare the extent of endothelial stretching and detachment. Results: The level of end tidal CO2 was maintained in the OT-EVH and OVH groups but increased significantly in the CT-EVH group (p=0.451, p=0.385 and p<0.001). Interestingly, partial arterial CO2 also did not differ over time in the OT-EVH group (p=0.241) whereas PaCO2 reduced significantly over time in the OVH group (p=0.001). A profound increase in PaCO2 was observed in the CT-EVH group (p<0.001). Consistent with these patterns, only the CT-EVH group demonstrated a sudden drop in pH over time (p<0.001) whereas pH remained stable for both OT-EVH and OVH groups (p=0.105 and p=0.869 respectively). Endothelial integrity was better preserved in the OVH group compared to OT-EVH or CT-EVH groups (p=0.012) and was not affected by changes in CO2 or low pH. Significantly greater stretching of the endothelium was observed in the open tunnel endoscopic OT-EVH group compared to the other groups (p=0.003). Conclusions: This study demonstrated that the different vein harvesting techniques impact on endothelial integrity; however this does not appear to be related to the increase in systemic absorption of carbon dioxide or to the pressurised endoscopic tunnel. The open tunnel endoscopic harvesting technique vein had more endothelial stretching compared to the closed tunnel endoscopic technique; this may be due to manual dissection of the vein. Further research is required to evaluate the long term clinical outcome of these vein grafts.

AB - To assess whether the use of carbon dioxide (CO2) insufflation has any impact on integrity of long saphenous vein comparing two types of endoscopic vein harvesting (EVH) and traditional open vein harvesting. Methods: A total of 301 patients were prospectively randomized into three groups. Group 1 control arm of open vein harvesting (OVH)(n=101), Group 2 closed tunnel (CO2) EVH (CT-EVH) (n=100) and Group 3 open tunnel (CO2) EVH (OT-EVH) (n=100). Each group was assessed to determine the systemic level of Partial arterial CO2 (PaCO2), end tidal CO2 (EtCO2) and pH. Three blood samples were obtained at baseline, 10 minutes after start of EVH and 10 minutes after the vein was retrieved. Vein samples were taken immediately after vein harvesting without further surgical handling to measure the histological level of endothelial damage. A modified validated endothelial scoring system was used to compare the extent of endothelial stretching and detachment. Results: The level of end tidal CO2 was maintained in the OT-EVH and OVH groups but increased significantly in the CT-EVH group (p=0.451, p=0.385 and p<0.001). Interestingly, partial arterial CO2 also did not differ over time in the OT-EVH group (p=0.241) whereas PaCO2 reduced significantly over time in the OVH group (p=0.001). A profound increase in PaCO2 was observed in the CT-EVH group (p<0.001). Consistent with these patterns, only the CT-EVH group demonstrated a sudden drop in pH over time (p<0.001) whereas pH remained stable for both OT-EVH and OVH groups (p=0.105 and p=0.869 respectively). Endothelial integrity was better preserved in the OVH group compared to OT-EVH or CT-EVH groups (p=0.012) and was not affected by changes in CO2 or low pH. Significantly greater stretching of the endothelium was observed in the open tunnel endoscopic OT-EVH group compared to the other groups (p=0.003). Conclusions: This study demonstrated that the different vein harvesting techniques impact on endothelial integrity; however this does not appear to be related to the increase in systemic absorption of carbon dioxide or to the pressurised endoscopic tunnel. The open tunnel endoscopic harvesting technique vein had more endothelial stretching compared to the closed tunnel endoscopic technique; this may be due to manual dissection of the vein. Further research is required to evaluate the long term clinical outcome of these vein grafts.

KW - Coronary artery bypass surgery

KW - Open vein harvesting

KW - Closed tunnel endoscopic vein harvesting

KW - Open tunnel endoscopic vein harvesting

KW - endothelial integrity.

U2 - 10.1097/IMI.0000000000000405

DO - 10.1097/IMI.0000000000000405

M3 - Article

VL - 12

SP - 320

EP - 328

JO - Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery

JF - Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery

SN - 1556-9845

IS - 5

ER -