Is endoscopic harvesting bad for saphenous vein graft patency in coronary surgery?

Endoscopic vein harvest (EVH) has quickly been adopted as the standard-of-care for coronary artery bypass grafting (CABG). Despite clear advantages in terms of wound morbidity, healing, pain, and patient satisfaction, data from recent large clinical trials have called the safety of this technique into question.

Post-hoc analyses of a variety of prospective trials have suggested EVH is associated with decreased graft patency, higher rates of cardiovascular complications (e.g. myocardial infarction, need for repeat revascularization) and mortality. Imaging studies of veins procured by EVH have revealed retained clot and vascular injury, particularly during the 'learning curve' of the technician. These findings may alter the quality of the conduit and, therefore, the outcome of the bypass graft. Elucidating the mechanisms that underlie any differences in results produced by the open and endoscopic procedures would help better inform clinical practice and the development of targeted strategies to improve EVH.

Clear clinical advantages over traditional open vein harvest have allowed EVH to rapidly become the standard-of-care for harvesting of one or more vein grafts during CABG. The quality of these conduits, suggested to be equivalent by early studies, has come into question as groups with varying levels of experience have adopted the endoscopic technique. Elucidating the principles of 'best practice' for vein harvest will likely help shorten the learning curve and improve the safety of EVH.