Early-term Outcomes And Experience Of No-touch Endoscopic Saphenous Vein Graft Harvesting
Rihito Tamaki1, Kohei Abe1, Kunihiko Yoshino2, Yuichi Nakamura1, Ryota Nakamura1, Hidefumi Nishida1, Hiroyasu Misumi1.
1St. Luke's International Hospital, Chuo-ku, Tokyo, Japan, 2Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Chiba, Japan.
BACKGROUND: Saphenous vein graft (SVG) is one of the most versatile and frequently used graft in coronary artery bypass surgery and an endoscopic vein harvesting (EVH) was developed to reduce its invasiveness. Recently, no-touch saphenous vein graft (NT-SVG) has been reported to increase graft patency, however, NT-SVG is often associated with wound complication. To address this issue, we developed a no-touch endoscopic vein harvesting (NT-EVH) technique. METHODS: NT-EVH is performed by initially dissecting the anterior and posterior surfaces of the connective tissue surrounding SVG, and then the lateral side of the SVG is dissected with a 0.5-1 cm gap. NT-EVH was initiated in 2018 and we retrospectively evaluated its early patency rate and perioperative characteristics. RESULTS: Between August 2018 and August 2022, 59 patients underwent coronary artery bypass grafting (CABG) with 63 endoscopically harvested NT-SVG grafts. The microscopic image revealed preserved intimal folding, perivascular connective tissue, lateral adipose tissue, and patent vasavasorum. The average age was 67.3±9.9, and 50 patients (84.7%) were male. 41 patients (69.5%) underwent off-pump CABG, and 11 patients (18.6%) underwent urgent or emergent surgeries. The mean ejection fraction was 51.2±13.5% and the mean Euro2 score was 3.05±4.12. The right coronary artery was the most common anastomotic site (91.5%). The early graft patency rate was 91.4% (53/58 grafts). Intraoperative graft flow tended to be lower in the early occlusion group of SVG compared to the patency group (25.0±8.0 vs 61.7±44.1 ml/min, p=0.071). There was a learning curve for NT-EVH (64.3±19.9min) and a correlation between case number and harvesting time (r=-0.425, p=0.001). No patient experienced lower extremity surgical-site infections requiring antimicrobial therapy.CONCLUSIONS: NT-EVH has demonstrated good results in early patency. In addition, it has very high potential for further development, with few wound complications and excellent cosmetic results. Further evaluation of long-term patency, and other aspects are required.
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