Endoskopische Saphenektomie in der Koronarchirurgie

Revolution oder Risiko
  • C. Suttner
  • A. Assmann
  • U. Boeken
  • P. Akhyari
  • A. Albert
  • A.  Lichtenberg
Übersicht

Zusammenfassung

Die V. saphena magna ist ungeachtet der zunehmenden Etablierung der vollständig arteriellen Myokardrevaskularisation ein unverzichtbarer Bestandteil der koronaren Bypasschirurgie. Die konventionelle Technik der offenen Venenentnahme („open vein harvesting“, OVH) und ihre Weiterentwicklung im Sinne der sogenannten Brückentechnik waren bis vor einigen Jahren die Standardverfahren im Rahmen aortokoronarer Bypassoperationen. Im Zuge der minimal-invasiven Chirurgie wurde die Technik der endoskopischen Venenentnahme („endoscopic vein harvesting“, EVH) entwickelt. Sie stellt insbesondere im Hinblick auf kosmetisches Ergebnis und Patientenzufriedenheit, aber auch hinsichtlich Häufigkeit und Schwere postoperativer Wundkomplikationen und -infektionen ein attraktives Alternativverfahren zur Gewinnung von Graftmaterial zur Myokardrevaskularisation dar. Kontrovers diskutiert werden die Qualität des endoskopisch entnommenen Venenmaterials sowie dessen Offenheitsrate im Langzeitverlauf, wobei jüngere Studien auch in diesen Punkten keine Vorteile für die OVH konstatierten.

Angesichts der derzeit uneinheitlichen Datenlage besteht im Sinne einer EBM der Bedarf an weiterer umfangreicher wissenschaftlicher Betrachtung.

Schlüsselwörter

Herzchirurgie Minimal-invasive Chirurgie Endoskopische Venenentnahme Wundinfektion Bypassoffenheitsrate 

Endoscopic vein harvesting in coronary bypass surgery

Revolution or risk

Abstract

Despite increasing establishment of total arterial revascularization of the myocardium, the great saphenous vein remains an essential component of coronary bypass surgery. Until recently, the conventional technique of open vein harvesting (OVH) and its advancement, the so-called bridge technology, were standard techniques in bypass surgery. In appreciation of minimally invasive surgery, the endoscopic vein harvesting (EVH) was developed. Especially in consideration of cosmetic results and patient contentment but also within regard to frequency and severity of postsurgical wound complication and infection, EVH presents an appealing alternative to extraction of graft material for myocardial revascularization. Controversy on quality and long-term patency of EVH graft material continues. However, recent trials were not able to show a significant difference with regard to patient outcome and bypass patency. Therefore, the EVH technique is currently considered to be a safe alternative to conventional OVH. However, in light of today’s heterogeneous data situation, further scientific studies are required in order to meet criteria for evidence-based medicine in this field.

Keywords

Cardiac surgery Minimally invasive surgical procedures Endoscopic vein harvesting Wound infection Graft patency 

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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • C. Suttner
    • 1
  • A. Assmann
    • 1
  • U. Boeken
    • 1
  • P. Akhyari
    • 1
  • A. Albert
    • 1
  • A.  Lichtenberg
    • 1
  1. 1.Klinik für Kardiovaskuläre ChirurgieHeinrich-Heine-UniversitätDüsseldorfDeutschland

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