Endoscopic vein harvest in elective off-pump coronary artery bypass grafting
While traditional open vein harvest was related to postoperative wound complications, endoscopic vein harvest was developed to minimize the morbidity in the greater saphenous vein harvest procedure. In this study, these two procedures were compared for postoperative wound healing and long-term graft patency. We reviewed all consecutive patients undergoing elective off-pump coronary artery bypass grafting from January 2004 to December 2005 and collected data regarding wound complications and coronary events. Wound complications included dehiscence, excessive discharge, edema, altered sensation, cellulitis, hematoma, pain scale, and superficial and deep wound infection. Coronary events were defined as diagnosis of myocardial infarction during the first year’s follow-up. A total of 392 patients were included in our series, among whom 44 were excluded from the study due to emergent operation, preoperative intra-aortic balloon pump support, or the greater saphenous vein varicose characteristic, 78 belonged to open vein harvest group, and 270 to endoscopic vein harvest group. Wound complications were significantly less in the endoscopic group (5.2%) compared to the open group (19.2%) (P=0.0002). There was no significant difference on preoperative risk factors, total operative time, or hospitalization days. During one-year follow-up, both the early and late graft patency rates were similar between the two groups. Endoscopic vein harvest is safe and effective, which carries less risk for wound complications and is associated with better satisfaction and cosmetic result than the traditional greater saphenous vein harvest procedure. The endoscopic vein harvest also demonstrates a great long-term patency.
Key wordsEndoscopic vein harvest (EVH) Open vein harvest (OVH) Off-pump coronary artery bypass grafting Greater saphenous vein (GSV) Internal mammary artery (IMA)
Unable to display preview. Download preview PDF.
- Allen, K.B., Griffith, G.L., Heimansohn, D.A., Robison, R.J., Matheny, R.G., Schier, J.J., Fitzgerald, E.B., Shaar, C.J., 1998. Endoscopic versus traditional saphenous vein harvesting: a prospective randomized trial. Ann. Thorac. Surg., 66(1):26–31. [doi:10.1016/S0003-4975(98)00392-0]PubMedCrossRefGoogle Scholar
- Graceley, R., 1986. Verbal Pain Assessment: Integrated Approach to Management of Pain. National Institutes of Health Consensus Development Conference. February 4, 1986, Baltimore.Google Scholar
- Kiaii, B., Moon, B.C., Massel, D., Langlois, Y., Austin, T.W., Willoughby, A., Guiraudon, C., Howard, C.R., Guo, L.R., 2002. A prospective randomized trial of endoscopic versus conventional harvesting of the saphenous vein in coronary artery bypass surgery. J. Thorac. Cardiovasc. Surg., 123(2):204–212. [doi:10.1067/mtc.2002.118682]PubMedCrossRefGoogle Scholar
- Lopes, R.D., Hafley, G.E., Allen, K.B., Ferguson, T.B., Peterson, E.D., Harrington, R.A., Mehta, R.H., Gibson, C.M., Mack, M.J., Kouchoukos, N.T., Califf, R.M., Alexander, J.H., 2009. Endoscopic versus open vein-graft harvesting in coronary-artery bypass surgery. N. Engl. J. Med., 361(3):235–244. [doi:10.1056/NEJMoa0900708]PubMedCrossRefGoogle Scholar