# Endoscopic Vein Harvesting by Less Experienced Operators Is Not Associated With Anastomotic or Graft Body Stenosis: A Propensity-Matched Angiographic Study

## TL;DR

This study finds that less experienced surgeons can safely perform endoscopic vein harvesting without increasing graft stenosis or adverse events.

## Contribution

It is the first to use detailed angiography and propensity matching to compare graft quality between novice and experienced EVH operators.

## Key findings

- No significant difference in graft occlusion or stenosis between novice and experienced EVH surgeons.
- MACCE-free survival rates were similar between novice and experienced groups over five years.
- Early SVG occlusion occurred in 5% of novice cases and 10% of experienced cases, with no statistical significance.

## Abstract

Objective: Endoscopic vein harvesting (EVH) has become a standard technique in coronary artery bypass grafting (CABG) due to its benefits in wound healing and recovery. However, EVH involves a learning curve, and concerns remain about graft quality with less experienced operators. Few studies have assessed graft failure patterns by anatomical location or used detailed postoperative angiography. This study evaluated the impact of EVH operator experience on saphenous vein graft (SVG) quality, focusing on early graft failure patterns such as anastomotic and graft body stenosis.

Methods: From 2005 to 2017, patients who underwent CABG with EVH at two institutions were analyzed. After propensity score matching, 60 patients each were assigned to novice (Group A) and experienced (Group B) EVH surgeon groups. Graft patency and major adverse cardiac and cerebrovascular events (MACCE) were compared during follow-up.

Results: Among 719 CABG patients, 173 underwent EVH and were included in the matched analysis. Early postoperative SVG occlusion occurred in three patients (5%) in Group A and six patients (10%) in Group B (P=0.355). SVG stenosis was observed in five (8.3%) and one (1.7%) patients, respectively (P=0.272). In-hospital and 30-day mortality were 1.7% (Group A) vs. 0% (Group B) (P=1.0). The one-, three-, and five-year MACCE-free survival rates were 96.4%, 90.7%, and 90.7% in Group A versus 96.0%, 91.3%, and 84.8% in Group B (P=0.175).

Conclusions: No significant differences were found between novice and experienced EVH surgeons in graft occlusion, stenosis, or major adverse cardiac events. EVH can be safely performed by less experienced surgeons under appropriate supervision.