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Is Endoscope Really Harmful For Heart-Bypass Patients?

Posted Oct 01 2009 10:06pm
During heart bypass surgery or what is also known as coronary artery bypass surgery, heart surgeons have to remove a blood vessel from the heart disease patient’s chest or leg and attach one end to the aorta and the other end to the coronary artery below the point where it is clogged. By doing so, the blood can then flow through the new vessel to the heart muscle the way it should. Aorta refers to the large artery coming out of the heart.

Data showed that the leg veins of about 70 percent of the bypass patients are being removed by endoscopes. The main reason is that it produces much less scarring and infection to the leg than the traditional method known as ‘open harvesting’, a technique that remove vein by directly cutting along a stretch of the leg.

Endoscopes have widely been used for various procedures and were utilized for vein harvesting for 13 years. Endoscopes are little cameras, which can be inserted, sometimes with surgical instruments, via a small incision in the skin.

Meant to be less invasive and gentler, the endoscopic technique of removing leg veins appeared to damage the veins and lead to heart attack, and in fact, it would cause patients 52 percent more likely to die within 3 years.

The study of 3,000 patients by researchers from Duke University Medical Centre in Durham, North Carolina reported on July 15, 2009 in the New England Journal of Medicine that veins removed by the endoscopic technique were significantly more likely to become clogged within a year or so.

Measurements at the end of 12 months and 18 months showed that 47 percent of the patients had at least 1 of their bypass grafts fail, while only 38 percent for those using older method of removing veins. Most patients had 2 or 3 grafts.

At the end of 3 years after the heart surgery, patients whose leg vein was removed using endoscopes had 38 percent higher risk of death or non-fatal heart attack. For death rate alone, the risk was 52 percent higher: 128 of the 1,753 patients with endoscopic technique died, as compared with only 71 died of the 1,247 patients who had open harvesting.

As stipulated in the report, though ‘open harvesting’ is no doubt more invasive and associated with more wound complications, it might be less traumatic to the vein and could result in a better conduit. After listening to the pros and cons of both techniques, most patients still prefer to adopt endoscopic technique, as patients rather choose the short-term benefits over the possible the long-term risks.
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