Influence of the caliber in Endoscopic Saphenous Vein Harvesting during Coronary Artery Bypass Grafting

Background

The required high degree of technical expertise is much more with the small caliber saphenous vein (SV) grafts using Endoscopic Saphenous Vein Harvesting (ESVH) during CABG Surgery and the patency may be affected. We thought to compare these small caliber vein grafted patients (GroupI) regarding their operative difficulties and mid-term graft patency with a controlled normal caliber grafted patients (groupII).

Methods

Retrospective data collection was from June 2013 to June 2016 in a consecutive order after exclusion of the first 50 patients done in our center. A cutoff point of 3 mm diameter of the SV was identified. GroupI (<3 mm) (34patients) was compared to GroupII (>3 mm) (100patients). ESVH procedure time and SV characteristics were compared between the groups and the incidence of perioperative myocardial infarction as well as the Myocardial Perfusion Imaging (MPI) for the mid-term patency rate. Patients who had been commented as having clinical varicosity and those who refused the (MPI) evaluation during the follow up period were excluded.

Results

Significant difference in the number of side branches and repaired small avulsed branches (GroupI vs. GroupII)(11.7 ± 4.8 vs. 9.7 ± 3.4) (P < 0.01) and (5.7 ± 1.7 vs. 1.7 ± 0.9) (p = 0.001) respectively. SV harvested required a longer time (min.) for total preparation (54.5 ± 14.8 vs. 39.9 ± 13.9 min) (p < 0.001) whereas the time required for endoscopy did not differ. The overall incidence of peri-operative myocardial infarction was (2.2%) with no significance between both groups. Normal/Mild ischemia in the territory of the venous graft (s) occurred in (88.2% vs. 91%) after a follow up period of (15.3 ± 7.9 m) that was non significant.

Conclusions

ESVH is feasible regardless the SV caliber with good mid-term patency rate in CABG patients. Small caliber SV needs longer time and more experience to be ready for usage but its quality can be better. The possibility of scoring the SV is difficult to be completely achieved except in the Operating Theater.