Long Term Survival Following Endoscopic Vein Harvest For Coronary Artery Bypass Grafting
Bilal H. Kirmani1, Stephen Powers1, Olivia Pennington2, Thomas Keegan2, Joanne Knight2, M N. Bittar1, Joseph Zacharias1.
1Blackpool Victoria Hospital, Blackpool, United Kingdom, 2Lancaster University, Lancaster, United Kingdom.
Background Poor uptake of Endoscopic Vein Harvest (EVH) in the United Kingdom has previously been attributed to concerns that the technique may be associated with higher rates of vein graft failure. Several studies have since shown equivalent mid-term mortality, and our aim was to determine the long-term survival of patients having endoscopic vein harvest.
Methods We analysed prospectively collected data for 8,556 consecutive patients undergoing isolated coronary artery bypass grafting at our institution from the start of our EVH programme to present day (2007 - 2017). A total of 1029 patients had EVH performed by a number of different practitioners. Total follow-up was up to 10 years (median 4.8).
Results Patients had similar pre-operative age, gender distribution, body mass index and comorbidity profiles. Fewer patients in the EVH group had poor left ventricular ejection fraction (3.2% vs 4.6%, p=0.044), Class IV angina symptoms (4.7% vs 6.9%, p=0.006) or Class IV dyspnoea symptoms (2.4% vs 3.4%, p=0.019). There was no difference in operative urgency, with emergent surgery in 1.2% of EVH and 1.6% open cases (p=0.35). Cardiopulmonary bypass times were similar between the two groups (Open 84.6 ± 58.3 vs EVH 87.3 ± 43.04, p=0.164) as was intensive care stay (Open vs EVH: 1.4 vs 1.4 days), total hospital stay (12.7 vs 12.3 days) and in-hospital survival (98.3% vs 98.1%). There was no difference in peri-operative complication rates. Kaplan-Meier curve analysis using the Log-Rank method demonstrated no difference in the long-term survival between open and EVH groups (71.5% vs 70.0%, p=0.86) (Figure 1).
Conclusion Our real world data demonstrates that EVH can be safely utilised with reassurance that there is no detrimental impact on long term survival. While our study lacks angiographic confirmation of patency or need for revascularisation as a surrogate marker, these data indicate that patients do not have increased long-term mortality risk from EVH.
Legend Kaplan-Meier survival curves of open vs endoscopic vein harvest 
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