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Prélèvement minimal invasif de la veine saphène interne pour pontages aorto-coronariens [Minimally invasive internal saphenous vein harvesting for coronary artery bypass]
Harvesting of the great saphenous vein for coronary artery bypass grafting is usually performed through long cutaneous incisions. We report our experience of minimally invasive harvest of the saphenous vein using the "Mini Harvest System". This device is composed of a blade coupled to a light source. Through a small cutaneous incision, the blade is placed under the skin and allows progressive dissection of the vein under direct vision. We compare this technique ("minimal invasive" group, n = 48) to the conventional method in which extensive incisions are performed along the saphenous vein course ("standard", n = 54). Both groups are comparable in term of age, sex, diabetes, peripheral arterial disease or obesity. The number of bypass performed is also comparable in the two groups. The ratio of the mean length of the cutaneous incision and the mean length of the vein was 35.4 +/- 5.9% for the "minimal invasive" group and 104.5 +/- 23.3% for the "standard" group (p < 0.001). The local complication rate is significantly reduced with a reduction in local post-operative pain (2% vs. 17%, p = 0.01), a better healing (100% vs. 79%, p = 0.01), a reduction in hematoma (31% vs. 52%, p = 0.03) and in oedema (37% vs. 59%, p = 0.03). We conclude that besides the evident aesthetic benefit, minimally invasive harvest of the saphenous vein allows for a better cicatrization and reduces the post-operative discomfort without compromising the aorto-coronary bypass procedure.
Aged, Coronary Artery Bypass/instrumentation, Equipment Design, Female, Humans, Male, Middle Aged, Saphenous Vein/transplantation, Surgical Procedures, Minimally Invasive/instrumentation
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