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OBJECTIVE: Coronary artery bypass surgery performed through median sternotomy remains an invasive operation. Efforts to reduce invasiveness include minimally invasive conduit harvest, already widely practised in the USA. Despite initial concerns regarding long-term vein graft patency, several studies have now demonstrated the safety of endoscopic vein harvesting (EVH). We present the process of introduction of EVH at our centre, leading to near total adoption of the technique at the present time.

METHODS: After a period of training, EVH was started in November 2009. In 2010 and 2011 over 50% of saphenous vein harvests were EVH, which rose to 73% in 2012 and 90% in 2013. Mid-term data was collected using patient telephone survey and national outcome databases.

RESULTS: Overall, of 2262 CABG ± other, EVH=1105 compared with 1157 cases of open vein harvest (OVH) for this period. There were no differences between the two groups with regard to preoperative characteristics, number of diseased vessels, ventricular function or other co-morbidities. EVH did not influence the duration of operation, bypass or cross clamp time. Postoperatively, there were no statistical differences in the rate of complications between the groups. Leg wound infection was three times higher in the OVH group compared to EVH (2.7 % versus 0.7%, p=0.004). In-hospital mortality (p=0.31) and reoperation for graft problems (p=0.49) were similar between the groups. Mortality data was collected from the UK Personal Demographics Service and showed no difference in survival at 3 years between the EVH and OVH groups (97.8 vs 97.5, p=0.3).

CONCLUSIONS: Our initial results of EVH on over 1000 patients demonstrated comparable results with OVH but lesser degree of wound infection rates. Medium term follow up showed equivalent survival in the two groups. EVH has become our standard of care, however long-term results will be followed and reported in future.