Influence of Endoscopic versus Traditional Saphenectomy on Event-Free Survival: Five-Year Follow-up of a Prospective Randomized Trial
Background: Endoscopic harvesting of the greater saphenous vein is increasingly used during cardiac surgery to improve patient satisfaction and reduce the wound complications associated with traditional open techniques. Although histologic studies suggest no significant difference in vein quality between these two techniques, long-term follow-up is lacking to address whether graft patency and event-free survival are influenced by the harvest method.
Methods: A total of 112 isolated coronary artery bypass patients were prospectively randomized to have veins harvested using either an endoscopic (n = 54) or traditional (n = 58) technique. Groups were demographically similar with regard to preoperative risk stratification and coronary procedures performed. Event-free survival (freedom from death, myocardial infarction, or recurrent angina) and use of outpatient resources for resolution of wound complications were determined. Follow-up was 100% at 5 years.
Results: Five-year actual event-free survival was similar in patients with endoscopic versus traditionally harvested veins (75% versus 74%, P = .85). The number of outpatient office visits required to manage each wound complication to complete resolution was significantly less following endoscopic versus traditional vein harvest (1.5 versus 6 visits, P = .001).
Conclusions: Wound complication management following endoscopic versus traditional vein harvest requires less resource utilization. Five-year follow-up of a prospective randomized trial demonstrates that use of endoscopic versus traditionally harvested saphenous veins does not influence event-free survival.
Allen KB, Shaar CJ. 1997. Endoscopic saphenous vein harvesting. Ann Thorac Surg 64:265-6.nAllen KB, Griffith GL, Heimansohn DA, et al. 1998. Endoscopic versus traditional saphenous vein harvesting: a prospective, randomized trial. Ann Thorac Surg 66:26-32.nAllen KB, Heimansohn DA, Robison JR, et al. 2000. Risk factors for leg wound complications following endoscopic versus traditional saphenous vein harvesting. Heart Surg Forum 3:325-30.nAllen KB, Heimansohn DA, Griffith GL, et al. 2000. Facile location of the saphenous vein during endoscopic vessel harvest. Ann Thorac Surg 69:295-7.nAllen KB, Fitzgerald EB, Heimansohn DA, Shaar CJ. 2000. Management of closed space infections associated with endoscopic vein harvest. Ann Thorac Surg 69:960-1.nCable DG, Dearani JA. 1997. Endoscopic saphenous vein harvesting: minimally invasive video-assisted saphenectomy. Ann Thorac Surg 64:1183-5.nDavis Z, Jacobs HK, Zhang M, Thomas C, Castellanos Y. 1998. Endoscopic vein harvest for coronary artery bypass grafting: technique and outcomes. J Thorac Cardiovasc Surg 116:228-35.nGriffith GL, Allen KB, Waller BD, et al. 2000. Endoscopic and traditional saphenous vein harvest: a histologic comparison. Ann Thorac Surg 69:520-3.nLumsden AB, Eaves FF, Ofenloch JC, Jordan WD. 1996. Subcutaneous, video-assisted saphenous vein harvest: report of the first 30 cases. Car-diovasc Surg 4:771-6.nUtley JR, Thomason ME, Wallace DJ, et al. 1998. Preoperative correlates of impaired wound healing after saphenous vein excision. J Thorac Cardiovasc Surg 98:147-9.n
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