Comprehensive angiographic evaluation of graft quality after endoscopic vein harvesting in coronary artery bypass grafting

TL;DR

This study compares endoscopic and open vein harvesting techniques in heart surgery, finding similar graft quality and fewer wound complications with the endoscopic method.

Contribution

The study provides angiographic evidence that endoscopic vein harvesting maintains graft quality without increasing complications compared to traditional methods.

Findings

EVH and OVH showed comparable saphenous vein graft patency rates (93% vs. 94%).

Wound complications were rare and similar between the EVH and OVH groups.

EVH showed a favorable trend in MACCE-free survival rates compared to OVH.

Abstract

The saphenous vein graft (SVG) remains a mainstay conduit for coronary artery bypass grafting (CABG) due to its accessibility and length. Although the no-touch technique may improve long-term patency, wound complications are a continuing concern. Since 2011, our institution has adopted endoscopic vein harvesting (EVH) as the standard approach. This study provides angiographic insights into graft quality and patency after EVH compared with open vein harvesting (OVH), with additional assessment of mid-term clinical outcomes.

Among 471 patients who underwent CABG between 2005 and 2017, 307 were included in this study. Patients were divided into the EVH group (Group A, n = 134) and the OVH group (Group B, n = 173). Postoperative coronary angiography was used to evaluate SVG graft patency, anastomotic integrity, and graft body stenosis. Clinical outcomes including major adverse cardiac and cerebrovascular events (MACCE) and wound complications were also compared.

Angiographic assessment demonstrated comparable SVG patency between the EVH and OVH groups (93% vs. 94%), with similar rates of anastomotic stenosis (2.2% vs. 2.3%) and severe graft stenosis (≥90%; 1.5% vs. 1.2%). No significant differences were observed in 30-day mortality (1.5% vs. 3.5%), in-hospital mortality (1.5% vs. 2.1%), or postoperative stroke. Wound-related complications were rare, including wound dehiscence (1.5% vs. 2.3%) and infection (0.7% vs. 1.2%). MACCE-free survival rates at 1, 3, and 5 years were 97%, 94%, and 91% in the EVH group vs. 92%, 86%, and 76% in the OVH group, respectively (p = 0.070), showing a favorable trend in the EVH group.

Detailed angiographic evaluation revealed that EVH did not compromise graft quality or patency compared with conventional OVH. The incidence of wound complications was very low, and early postoperative SVG-related events were favorable. These findings suggest that EVH is a safe and reliable harvesting technique, providing high-quality grafts with excellent angiographic integrity. Individualized selection of harvesting strategy remains important for optimizing surgical outcomes.

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