A randomized trial of endoscopic versus open saphenous vein harvest in coronary bypass surgery

Background. The purpose of this study was to determine whether or not endos copic vein harvest is a reliable, beneficial, and cost-effective method for saphenous vein harvest in coronary bypass surgery (CABG). Methods. A total of 100 patients having primary CABG were prospectively ran domized to either endoscopic (EVH; n = 47) or open saphenous vein harvest ( OVH; n = 50). Three patients in the EVH group required both techniques and were excluded from analysis. Results. The groups did not differ in preoperative characteristics, includi ng: age, gender, left ventricular function, height, weight, percent over id eal body weight, incidence of diabetes, peripheral vascular disease, or pre operative laboratory values (creatinine, albumin, or hematocrit). The EVH g roup had longer vein harvest and preparation times than the OVH group, whil e the incision length was significantly shorter. There was no difference be tween groups in mortality, perioperative myocardial infarction, intensive c are unit or postoperative length of stay, blood product utilization, or dis charge laboratory measures. There was more drainage noted from leg incision s at hospital discharge in the OVH (34%) versus EVH group (8%; p = 0.001), but more ecchymosis in the EVH group. Although there was a trend towards re duced leg incision pain in the EVH group, there was no statistically signif icant difference in pain or in the quality of life measure at any point in time. There was no difference between groups in readmission to hospital, ad ministration of antibiotics, or incidence of leg infection. While mean hosp ital charges for the EVH group were approximately $1,500 greater than for O VH, this difference did not reach statistical significance. Conclusions. EVH is a safe, reliable, and cost-neutral method for saphenous vein harvest. The best indication for EVH may be in patients who are at in creased risk for wound infection and in those for whom cosmesis is a major concern. (C) 1999 by The Society of Thoracic Surgeons.