Early and Mid-term Outcomes of Endoscopic Saphenous Vein Harvesting in Coronary Artery Bypass Grafting

(Department of Cardiovascular Surgery, Teikyo University Hospital, Tokyo, Japan, and Department of Cardiovascular Surgery, Sakakibara Heart Institute*, Tokyo, Japan)

Shigefumi Matsuyama Toshihiro Fukui* Minoru Tabata*
Nobuhiko Hiraiwa* Akihito Matsushita* Kenichi Sasaki*
Shuichiro Takanashi*
In this study, we report early and mid-term outcomes of endoscopic saphenous vein(SV)harvesting(EVH)for coronary artery bypass grafting. EVH is expected to have superior cosmetic results and fewer wound complications than conventional open techniques. EVH was performed in 262 patients from April 2008 to December 2010. From September 2010, we have administered heparin before EVH to prevent intraluminal SV clot formation. The mean age of the patients was 70±7.3 years, and 178(67.9%)patients were men. The success rate of EVH was 97.3%. Hospital mortality was 1.2%. Postoperative wound complications occurred in only 7(2.8%)patients. The early and mid-term patency was 95.8%(276/288)and 74.2%(187/252), respectively, as evaluated by postoperative angiography or computed tomography. Comparing the mid-term patency rate between the groups with or without systemic heparinization before EVH, statistical significance was not observed, but the mid-term patency was good in the group with systemic heparinization(82.5% vs. 73.6%,p=0.16). Actuarial 1-year and 3-year survival were 93.9% and 79%. Actuarial 1-year and 3-year major adverse cardiac event-free rates were 92.2% and 77.5%. In 10 patients who had SV graft occlusion during the observation period, percutaneous coronary intervention was required for the native coronary artery. EVH has great cosmetic advantages and has a good early patency. However, the mid-term patency is not satisfactory. Thus, systemic heparinization before EVH, improvement of the device and further clinical experience and techniques are required to improve the mid-term and late patency.
  Jpn. J. Cardiovasc. Surg. 42:103-107(2013)

Keywords:great saphenous vein, endoscopic graft harvesting, graft patency rate, wound complications