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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Semih Buz Roland Hetzer Permission Requests Google Scholar Articles by Potapov, E. V. Articles by Hetzer, R. PubMed Articles by Potapov, E. V. Articles by Hetzer, R. Related Collections Anesthesia Extracorporeal circulation Peripheral vascular

Letters to the Editor

Reply to Sinha et al.

Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353 Berlin, Germany

Received 8 October 2007; accepted 10 October 2007.

^_* Corresponding author. Tel.: +44 30 4593 2062; fax: +44 30 4593 2079. (Email: potapov{at}dhzb.de).

Key Words: Coronary artery bypass grafting • Minimally invasive vein harvesting • CO₂ embolism • Varicosis

The question of adequate monitoring during endoscopic vein harvesting has been raised [1].

Endoscopic vein harvesting is now a well-established and safe procedure. The very rare case of hemodynamically evident CO₂ embolism that we reported was the only one at our institution during the first 50 procedures and, in experienced hands, it may be completely avoided. After this happened we changed our harvesting technique: (a) we no longer use CO₂ pressure over 12 mmHg and (b) in the case of severe bleeding from varicose vein we continue with an open technique. In our later experience, with over 300 cases, no more CO₂ embolism occurred. We do not employ additional end tidal carbon dioxide (ETCO₂) monitoring because hemodynamic deterioration may be detected much more quickly by continuous monitoring of the central venous pressure (CVP) and mean arterial pressure (MAP), as well as by direct inspection of the heart during preparation of the mammary artery. If Dr Sinha et al. feel that in the absence of transesophageal echocardiography (TEE) or ETCO₂ monitoring endoscopic vein harvesting is unsafe, we recommend continuous TEE monitoring during the procedure, as already mentioned in our report [2]. It is a rule in our institution that a primed cardiopulmonary bypass circuit and a perfusionist are always available in the OR so that, if hemodynamic deterioration occurs, cardiopulmonary CPB can be initiated without any delay.

We recommend the use of both TEE and ETCO₂ monitoring during the learning curve or in cases with atrial shunts or varicosis. Now, having performed endoscopic vein harvesting in over 300 patients, in standard cases we use TEE mostly in stand-by.

References

1. Sinha PK, Jayant A, Kumar B. The need for monitoring during endovascular vein harvesting. Eur J Cardiothorac Surg 2008;33:137.[Medline]
2. Potapov EV, Buz S, Hetzer R. CO₂ embolism during minimally invasive vein harvesting. Eur J Cardiothorac Surg 2007;31:944-945.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Semih Buz Roland Hetzer Permission Requests Google Scholar Articles by Potapov, E. V. Articles by Hetzer, R. PubMed Articles by Potapov, E. V. Articles by Hetzer, R. Related Collections Anesthesia Extracorporeal circulation Peripheral vascular