Background: The endoscopic saphenous vein harvesting (EVH) introduced in coronary artery bypass surgery (CABG) is associated with less wound complication and postoperative pain. Carbon dioxide (CO 2 ) insufflation is used during EVH to facilitate the procedure. The purpose of this study was to determine whether the incidence of CO 2 embolism during EVH with CO 2 insufflation could be reduced with lower CO 2 insufflation pressure. Methods: Four hundred and ninety-eight consecutive patients scheduled for elective off-pump CABG were prospectively studied. These patients were randomly assigned into high and low groups in which 15 and 12 mm Hg CO 2 insufflation pressures were used during EVH, respectively. Multiplane transesophageal echocardiography (TEE) with transgastric inferior vena cava view was used to monitor the appearances of CO 2 bubbles. If a burst of many CO 2 bubbles were found by TEE, the CO 2 insufflation would be stopped until detailed examination of the operative field. Results: The incidence of CO 2 embolisms in the high group of patients (13.3%) was significantly higher than that in the low group (6.5%, p < 0.05). Two episodes of emergent cessation of CO 2 insufflation occurred in the high group of patients. No massive CO 2 embolism with significant hemodynamic alterations occurred in either group. Conclusions: The incidence of CO 2 embolisms during EVH could be reduced with lower CO 2 insufflation pressure, which, in combination with increased surgical experience and continuous TEE monitoring of the inferior vena cava, helps to reduce the risks of massive CO 2 embolism. © 2006 The Society of Thoracic Surgeons.
Chiu, K. M., Lin, T. Y., Wang, M. J., & Chu, S. H. (2006). Reduction of Carbon Dioxide Embolism for Endoscopic Saphenous Vein Harvesting. Annals of Thoracic Surgery, 81(5), 1697–1699. https://doi.org/10.1016/j.athoracsur.2005.12.040