Antibiotic Use, CABG-patients, Cardiac Surgery, Coronary Artery Bypass Graft With or Without ECC, Endoscopic Surgery, Off Pump Coronary Artery Bypass Graft, Saphenectomy, Wound Complications
Conditions
Keywords
endoscopic vein harvesting, CABG surgery, open vein harvesting, wound morbidity
Brief summary
The goal of this clinical trial is to compare two different techniques: endoscopic saphenous vein harvesting versus conventional open harvesting in patients undergoing coronary artery bypass grafting, either alone or in combination with another cardiac surgical procedure (valve surgery or arrhythmia surgery). The main questions the trial aims to answer are: Does the endoscopic technique reduce surgical wound morbidity in terms of shorter hospital stays? Does endoscopic saphenous harvesting reduce the use of antibiotics for saphenectomy wound infections? Does the endoscopic technique reduce need for wound dressings due to necrosis and/or wound infection, and reduce need for analgesic treatment for wound pain? This prospective, randomized study will be conducted in the Cardiovascular Surgery Service at Hospital Clínico San Carlos. Participants will be randomly assigned to a different saphenectomy technique. All patients will be assessed for saphenectomy wound complications upon discharge, and by phone call at 7 days, 1 month, and 3 months following the intervention.
Detailed description
* Pain in the leg incisions will be assessed using a standarized pain scale. * Antibiotic and analgesic requirements for infection or pain in the saphenous vein surgical wound will be documeted. * The need for outpatient treatment or hospitalization due to surgical wounds will be evaluated. * A surgical wound cosmetic satisfaction survey will be administered to participants. * Images of the saphenectomy surgical wound will be collected at 1 month postoperatively. * Major cardiovascular events will be monitored during follow-up visits or hospital admissions and recorded in the RECC database (local service database)
Interventions
PROCEDUREHarvesting of the saphenous vein graft
Most existing studies on endoscopic saphenectomy have been conducted in CABG with cardiopulmonary bypass (CBP), whereas most CABG surgeries at the study center are performed without CBP. The following outcomes will be identified: * Days of admission or need for hospitalization * Use of antibiotic therapy for saphenectomy wound infections * Need for wound dressings due to necrosis and/or wound infection * Need for analgesic treatment for wound pain
Sponsors
Hospital San Carlos, Madrid
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Investigator)
Intervention model description
One group will receive the open technique for saphenous vein harvesting and the other group will receive the endoscopic technique.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients undergoing coronary artery bypass grafting (CABG), alone or in combination with other surgery (valve or arrhythmia surgery), with or without cardiopulmonary bypass (CPB), in which preoperative evaluation includes the plan to use a short saphenous vein segment (alone or in addition to arterial conduits). * Availability of a surgeon or cardiac surgery resident trained in endoscopic harvesting in the operating room. * Patients undergoing myocardial revascularization surgeries with or without extracorporeal circulation. * Patients undergoing concomitant cardiac valve replacement surgery, atrial fibrillation surgery, and others, in addition to CABG
Exclusion criteria
* Emergent surgery or procedures performed during cardiorespiratory arrest * Myocardial revascularization with arterial grafts only * Presence of varicose veins * History of infrainguinal vascular surgery * Presence of ulcers and/or active infection in the lower limbs * Previous stroke with neurological sequelae in the legs * History of deep vein thrombosis in the legs * Pregnancy * Age under 18 years * Lack of signed informed consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Wound morbidity | From enrollment to the three-month follow-up visit | Days of hospital stay, use of antibiotics for saphenectomy wound infections, need for wound dressings due to necrosis and/or wound infection, and need for analgesic treatment for wound pain. 1. Length of Hospital Stay. Unit of Measure: Days 2. Use of Antibiotics for Saphenectomy Wound Infections Measure: Number of participants requiring oral or parenteral antibiotics due to wound infection. Unit of Measure: Participants 3. Need for Wound Dressings Due to Necrosis and/or Infection Measure: Number of participants requiring wound dressings due to necrosis and/or wound infection. Unit of Measure: Participants 4. Use of Analgesics for Wound Pain Measure: Number of participants requiring analgesic treatment for saphenectomy wound pain |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Freedom from combined cardiac events | 1 year | Freedom from death, myocardial infarction, and recurrent angina |
Countries
Spain
Contacts
Primary ContactMaría B Solís Chávez, MD
Outcome results
None listed