Endoscopic Vein Harvesting Early Adoption: Is it Worth the Trouble?

Abstract

Introduction: The long saphenous vein remains to be the most utilised conduit in coronary artery bypass grafting (CABG). The most used technique in harvesting this conduit in Australia is the open vein harvest (OVH). Endoscopic vein harvesting (EVH) has become an alternative technique that is now mostly used in the United States and holds promise in decreasing leg wound morbidity, increasing patient wound satisfaction, and reducing long-term costs. Methodology: A retrospective multiple-cohort study was carried out, comparing isolated CABG cases that utilised EVH with isolated CABG cases that made use of OVH over the period between February and July, 2016 at our institution. A total of 110 isolated CABG cases was identified, 23 utilising EVH (20.9%) and 87 using OVH technique (79.1%). Retrospective analysis of the data from each case including preoperative to postoperative management was performed, specifically comparing rate of leg wound complications, and further management post discharge. Results: Isolated CABG cases using EVH had one leg wound complication at the time of the patient's discharge (4.3% of EVH group), compared to eleven leg wound complications in the OVH group (12.6% of OVH group) that necessitated further management and follow-up either with the our unit's wound clinic or the patient's GP. Conclusions: Endoscopic vein harvesting even in its early adoption already has a positive impact in terms of further decreasing infection rates and therefore decreasing postoperative management costs. Further studies are now needed looking at long-term patient survival.