Improved Leg Wound Healing with Endoscopic Saphenous Vein Harvest in Coronary Artery Bypass Graft Surgery: A Prospective Randomized Study in Asian Population

Abstract

Conventional open saphenous vein harvest (OVH) for coronary artery bypass graft surgery is often associated with significant pain and morbidity. This study aims to determine whether endoscopic saphenous vein harvest (EVH) reduces leg wound morbidity and improves patient satisfaction as compared to OVH in Asian population. Between March 2005 and June 2006, 120 patients who underwent isolated CABG were prospectively randomized into EVH (n = 60) and OVH (n = 60) groups. VirtuoSaph (Terumo Cardiovascular Corp., Ann Arbor, MI, USA) harvesting system was used for EVH. We analyzed leg wound complications (ASEPSIS score), postoperative pain, satisfaction, and clinical outcomes. Fisher's exact test and Mann-Whitney U test were used for categorical and continuous variables analysis respectively. Six patients in the EVH group required conversion to open technique. Both groups had matched demographic characteristics and risk factors. Mean numbers of grafts performed were 3.2 +/- 0.6 (EVH n = 54) and 3.0 +/- 0.7 (OVH n = 60) (p = 0.03). ASEPSIS scores at postoperation days three, seven, and 21 were significantly lower in the EVH group than the OVH group (p = 0.02, p = 0.002 and p = 0.01, respectively). Wound pain scores at postoperative days three, seven, and 21 were significantly lower in the EVH group (p = 0.000, p = 0.001 and p = 0.000 respectively). Wound numbness was found in 5.7% of the EVH group and 33.3% of the OVH group patients (p = 0.01). [Six patients required conversion to open technique.] There was one hospital mortality (OVH group) and major postoperative complications were not significantly different between the groups. EVH system is a safe and effective alternative to OVH with better wound healing, reduced postoperative pain, and wound numbness. However, the higher conversion rate to OVH in Asian patients requires further evaluation.