Benefits of Endoscopic Vein Harvesting in Coronary Artery Bypass Grafting

Abstract Background Earlier reports concerning endoscopic vein harvesting were controversial regarding the patency of the vein graft after coronary artery bypass grafting (CABG). In addition, data on the quality of life are lacking. In this study, we investigated our experience with endoscopic vein harvesting with regard to these endpoints. Methods Patients undergoing isolated CABG between 2012 and 2016 were included in the analysis. Patients were divided in two groups stratified by the technique of saphenous vein harvesting: open versus endoscopic. Primary endpoints were the rate of repeat revascularization and leg wound complications. Secondary endpoints were the physical and mental quality of life scores of the SF-36 questionnaire. Cox proportional hazard analysis was performed to adjust the endpoint of repeat revascularization for relevant covariates. Results In total, 2123 patients were included in the open group, while 883 patients were included in the endoscopic group. Overall mortality was not significantly different between both groups (p=0.060). Revascularization-free survival was similar between both groups (adjusted HR, 0.65; 95% CI, 0.42-1.02; p=0.059). Endoscopic vein harvesting is significantly associated with a decreased hazard for the combined endpoint of death or repeat revascularization (adjusted HR, 0.64; 95% CI, 0.46-0.89; p=0.008). Significantly more leg wound complications were seen in the open group (n=24 versus n=0; p=0.002). Postoperative quality of life showed no significant differences between the two groups. Conclusions Apart from the benefits on leg wound complications, endoscopic vein harvesting was comparable to open vein harvesting in terms of rate of repeat revascularization and quality of life.