Systemic Effects of Carbon Dioxide Insufflation during Saphenous Vein Harvesting in Patients undergoing Coronary Artery Bypass Grafting

Abstract Objectives : The objectives of this study were to determine the efficacy of endoscopic saphenous vein harvesting in coronary artery bypass grafting (CABG) and to determine the time course of the carbon dioxide (CO2) embolism with transesophageal echocardiography (TEE) monitoring. Methods : A total of 260 consecutive cardiac patients scheduled for off-pump coronary artery bypass graft using saphenous vein harvesting were included. These cases were randomly divided into 2 groups, Group A using low-flow CO2, and Group B for high-flow CO2 insufflation during saphenous vein harvesting. Echocardiography was done throughout the procedure by monitoring CO2 bubbles in the inferior vena cava and circulatory system. Results : In this study, a total of 260 patients were studied to determine the outcomes of patients who underwent CO2 insufflation during saphenous vein harvesting at CABG in terms of demographic, operative, and postoperative variables. The ROC curve shows 87% sensitivity of TEE in the prediction of CO2 embolism according to the quantity of bubbles during harvesting of the vein. There are non-significant differences between values of arterial blood gases (ABG, O2/CO2) nor end-tidal CO2 before, during, and after vein harvesting with fewer logistic regression curves for low-flow over high-flow groups according to levels of End-tidal CO2 across the procedure. Conclusions : We conclude that the incidence of CO2 embolisms during endoscopic vein harvesting could be reduced using lower CO2 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 CO2 embolism.