Short and long term results of Endoscopic Vein Harvest- A single Trust Experienc
Chimzie Uchime, Toufan Bahrami.
Harefield Hospital, London, United Kingdom.
OBJECTIVE: Long saphenous vein, commonly used in Coronary Artery Bypass grafting (CABG), is classically harvested via open technique (OVH). Endoscopic Vein harvest (EVH) technique introduced since 1996 has had a slow uptake especially in Europe compared to United States. The reason being concerns over the endothelial integrity and consequent long term patency of EVH grafts compared to OVH grafts. To date there has been no randomised trial that has tackled this controversy, results of REGROUP trial is still years away. In out trust EVH has been in use alongside OVH since 2007. We aim to present a comparative short and long term outcomes of EVH vs OVH from 2007-2014.
METHODS: We retrospectively analysed prospectively collected data from two institutions surgical database within the same trust. Inclusion criteria were; isolated or combined CABG, at least one saphenous vein graft received and saphenous vein was harvested using EVH or OVH. These were propensity score matched. Then the short term outcomes ( surgical site infection, operative mortality) and long term outcomes -median follow up of 3.6years - ( late survival, freedom form repeat revascularisation, composite of freedom from repeat revascularisation and myocardial infarction) were analysed.
RESULTS: Among the matched group (1432 cases in each arm) there was no statistical difference in 30 day mortality, with the EVH group having a lower mortality (2.5%) compared to the OVH (3.2 %). EVH has significantly less leg wound infections (P=0.0001). There was no statistically significant difference in the long term outcomes.
CONCLUSIONS: EVH gives better leg wound results. However the long term outcome, as regards graft patency is still largely unproven and questioned. Our results are equivocal on this. This is however a non-randomised study. It makes REGROUP study all the more pertinent.
Survival in the matched sample (1=EVH: endoscopic vein harvesting; 0=OVH: open vein harvesting)
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