New devices cut LOS and costly complicationsRapid, atraumatic endoscopic harvesting of the saphenous vein for use in coronary artery bypass surgery is gaining favor among your colleagues. The procedure results in improved clinical outcomes: fewer wound complications, fewer readmissions, and decreased need for office follow-up than the traditional open method. (See charts, p. 140, courtesy of Marc Gerdish, MD, Cardiac Surgery Associates, Central Dupage Hospital, Winfield, IL.) Donor site infections can add $8,500 on average to the cost of hospitalization for cardiac surgery.1 Length of stay can double due to wound complications, adding upward of $9,900.2
Early data from a clinical study comparing endoscopic to traditional harvesting shows that the newer technique significantly reduces pain and leads to earlier and improved ambulation.3 Also, vein quality was judged to be good in a clinical study comparing the procedures.4 Each showed preserved intimal structure. The VasoView Uniport (Guidant, Indiana polis), was introduced in August. The device requires only a single, 2 cm incision, allowing for a quicker procedure, fewer complications, less pain, accelerated ambulation, and improved cosmetics. (See photos, at right and on p. 140, courtesy of Marc Gerdish, MD.)
1. Kaiser AB, et al. Efficacy of cefazolin, cefamandole, and gentamicin as prophylactic agents in cardiac surgery. Ann Surg 1987; 206:791-797.
2. DeLaria GA, et al. Leg wound complications associated with coronary revascularization. J Thorac Cardiovasc Surg 1981; 81:403-407.
3. Morris R. Facts and myths of minimally invasive cardiac surgery. Seminar presented at Current Trends in Thoracic Surgery IV, January 1998.
4. Chin A, et al. Endoscopic cardiovascular vessel harvesting. 6th World Congress of Endoscopic Surgery. Oral communication, posters, and videos. June 1998; 875-879.