Minimally invasive saphenous vein harvesting: Effects on endothelial and smooth muscle function

Background. The long saphenous vein remains the commonest conduit used in c oronary artery bypass grafting procedures. Surgical trauma during vein harv esting can cause endothelial and smooth muscle injury that has important im plications for vein graft longevity. Minimally invasive vein harvesting is advocated to reduce wound morbidity. However, the functional consequences o f increased handling and traction, with potentially detrimental effects, re main unknown. Methods. Forty patients were prospectively randomized into either a minimal ly invasive (minimal) or traditional (open) saphenous vein harvest group. S mooth muscle contractile function was assessed by responses to potassium ch loride and phenylephrine. Endothelial cell function was assessed by respons es to serial escalations in concentration of acetylcholine, bradykinin, cal cium ionophore, sodium nitroprusside, and N-nitro-L-arginine using isometri c tension studies. Results. Harvest times were similar for both groups. The total incision len gth in the minimal group was significantly shorter than in the open group. There were no differences in smooth muscle contractions to either receptor- independent or receptor-mediated agonists between the two groups. Similarly , vasorelaxation in response to both endothelium-dependent and endothelium- independent agonists were similar in both groups. Conclusions. Minimally invasive saphenous vein harvesting is associated wit h similar medial smooth muscle and endothelial function as open harvesting. These findings suggest that minimally invasive harvesting techniques can b e used without major detrimental effects on vascular integrity. (Ann Thorac Surg 2001;71:1503-7) (C) 2001 by The Society of Thoracic Surgeons.