St. Boniface Hospital Foundation donors have changed the way Cardiac Sciences St. Boniface Hospital performs some cardiac surgeries at St. Boniface Hospital, making them safer and dramatically reducing the number of infections and other complications in patients.
Donors made it possible for Manitoba’s Cardiac Centre of Excellence to be the first facility in Western Canada to offer an endoscopic vein harvesting (EVH) program to patients as part of coronary artery bypass grafting surgeries. Bypass grafting is needed in about 400 to 600 cases at the Hospital each year.
The first patient to benefit from EVH at St. Boniface was a gentleman in his 50s, who underwent the procedure in January 2023. As a daily runner, getting back on his feet as soon as possible post-surgery was important to him.
“We are beyond grateful to donors for giving us this opportunity,” said Nancy Luxa-Le Blanc, the Physician Assistant at Cardiac Sciences St. Boniface Hospital who performed the operation. “To our care team, the introduction of EVH is the most exciting thing that has ever happened.”
The delicate surgery uses blood vessels harvested from another part of the body, most often the patient’s leg. Luxa-Le Blanc explained using her finger as an example.
“Let’s say my finger is an artery on the heart. My knuckle here is the blockage. So, we attach something just before the blockage, and just after, onto the heart, and that stays permanently.”
About three to six bypasses are done on any given patient/in an average procedure, requiring at total of 45 to 90 centimeters of vein, using about 15 centimeters of vein for each bypass.
Older method required large incision
Taking blood vessels from the leg or arm has traditionally been done using an open vessel harvesting method at St. Boniface. It required the surgeon to make large incisions along one leg, often from ankle to groin. The Hospital’s first EVH patient, mentioned above, would have needed an incision at least from his knee to groin otherwise.
With such a large incision, there is always the risk of complications. The infection rate can be as high as 17 to 20 per cent. “When you get a leg infection it means up to two weeks’ extra hospital stay, antibiotics in hospital, numerous post-op visits to the clinic, and maybe home care for wound dressings,” said Luxa-Le Blanc.
“Harvesting the vein openly is a feat unto itself. Then we have to close the whole leg, which is extremely time-consuming. We need an extra assistant to go help at the chest, for the open-heart surgery, while one person is closing the leg. It takes three layers of suturing to close properly.”
New system reduces complications
With the new EVH system, after proper positioning of the patient and finding the location of the vein, a two-centimetre incision is made, often above the knee, and the endoscopic instrument (called the dissector) is carefully inserted.
“When you see patients recovering and going home earlier, with fewer complications, it is amazing. It is a gift. It is a blessing.”
“We’re able to follow it up the vein using the camera, then it is cut free and removed,” she explained. This practice does not harm the remaining blood vessel network, which heals and keeps enough blood flow to the leg.
“When you see patients recovering and going home earlier, with fewer complications, it is amazing. It is a gift. It is a blessing,” she said.
“Every day that I get to pick up these instruments, there is an absolute thankfulness in me. I am very grateful to our donors. I just want them to really see how important this is.”
Advantages of EVH
- 92% fewer wound complications
- Reduced post-operative pain by 81%
- Disturbances in mobility decreased by 69%
- 1-day shorter length of stay
- 97% fewer total wound clinic visits
- Overall treatment requirements and total wound care costs were 96% lower for EVH patients.
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