The Application Of No Touch Saphenous Vein Graft In Coronary Artery Bypass Grafting On The Beating Heart

Objective: Coronary heart disease is an important cause of death caused by diseases worldwide,and coronary artery bypass grafting is an effective method for the treatment of coronary heart disease.However,the main problems faced by the conventional saphenous vein grafts in the early stage are acute thrombosis and intimal hyperplasia,which is also an important cause of venous graft occlusion rate of 10-20% in the first year.This is followed by progressive atherosclerotic lesions,with an occlusion rate of more than 50% of the vein graft after 10 to 15 years.The patency rate of grafts is closely related to the quality of life of patients undergoing coronary artery bypass grafting.In this case,this forced the cardiac surgeon to improve the surgical method and explore new techniques,and the no-touch saphenous vein acquisition technique was one of the methods,which was performed by the Swedish doctor Souza in 1996.The first report was applied,and the literature showed a good long-term patency rate.The potential risk factor for the application of this technique is that when the saphenous vein is covered by the perivascular tissue,the venous texture cannot be fully evaluated and the blood expenditure on the side of the vein can not be fully examined.There may be collateral bleeding after surgery,and again Increased operative time and concerns about increased risk of secondary thoracotomy and whether to increase recent perioperative risk.Furthermore,the application of no-touch technology compared with conventional saphenous vein acquisition technology has the advantage of morphological structure research,whether there is microscopic difference between the two,in order to influence the long-term patency rate.In the coronary artery bypass grafting which is performed on the beating heart,the conventional technique of saphenous vein was used as a control to study whether the application of no-touch technique to obtain the saphenous vein increased the perioperative intraoperative and postoperative risks,and the two acquisition methods were obtained.The difference in morphological structure of the great saphenous vein in two groups.Methods: A total of 40 cases of first-ever beating coronary artery bypass grafting were enrolled in the study,including the no-touch technique for saphenous vein acquisition and the conventional technique for saphenous vein acquisition.(1)Perioperative data of two groups of patients were collected,including intraoperative data: time of acquisition of saphenous vein,total operation time,etc.;postoperative data: drainage volume 24 hours after surgery,time of ventilator after surgery,postoperative In the intensive care unit,postoperative TNI changes,postoperative hospital stay,4 weeks of lower extremity infection rate,secondary thoracotomy rate and mortality within 1 month after surgery,the difference between the two groups(2)surgery Among the patients with more saphenous veins,the difference in tissue structure between the two groups was compared under light microscope.Results: Perioperative risk: The time of maximal saphenous vein acquisition was significantly longer in the no-touch group than in the conventional group,with an average of 45 min versus 30 min,P = 0.000.There were no statistically significant differences in total operative time,postoperative drainage,postoperative troponin I changes,ventilator application time,postoperative intensive care unit stay,and total length of hospital stay.Incision infection rate and operative mortality in the lower extremities There was no difference in waiting.Morphological structure: no-touch saphenous veins performed better than conventional saphenous veins.In the conventional group,the endothelial cells of the saphenous vein were loosely arranged,irregularly arranged,and the endothelial cells were flat;the smooth muscle cells were vesicular-like;the outer layer was incomplete,a small amount of nourishing blood vessels were destroyed,and inflammatory cells were observed.No-touch large saphenous vein group: vascular endothelial cells remained more intact,and continuous array of endothelial cells can be observed.The morphology of endothelial cells was full and intact;the arrangement of smooth muscle cells was more regular;the outer membrane layer remained more intact,and the surrounding nourishing blood vessels were obviously more abundant.Conclusion: In the coronary artery bypass grafting on the beating heart,the use of no-touch technology to obtain the saphenous vein did not increase the risk during the perioperative period,and the saphenous vein obtained by the no-touch technique was used to obtain the saphenous vein.The great saphenous vein obtained with respect to conventional techniques was more advantageous in morphological structure.The application of No-touch saphenous vein acquisition technique is safe and feasible in the technique of beating coronary artery bypass grafting.It is a promising technique worthy of further study.