Early Results of Endoscopic Versus Open Saphenous Vein Harvesting in Coronary Artery Bypass Grafting: A Single Blinded Randomized Controlled Trial

Background: The great saphenous vein (GSV) remains the most commonly used conduit worldwide for the majority of coronary artery bypass surgery (CABG) procedures, despite concerns regarding the long-term patency of arterial revascularization. Therefore, our aim is to assess and demonstrate the impact of harvesting techniques on patient quality of life and early post-operative outcomes.

Methods: This prospective, single-blinded randomized controlled study enrolled patients with ischemic heart disease indicated for CABG. The study was conducted at the Cardiothoracic and Vascular Surgery Center (CVSC) at Mansoura University, Mansoura, and El-Galaa Military Hospital, Cairo, involving 32 patients. Patients were categorized into two groups: Group I comprised sixteen patients where the GSV was harvested using the open vein harvesting technique (OVH), and Group II included sixteen patients where the GSV was harvested using the endoscopic vein harvesting technique (EVH).

Results: Multivariate regression analysis evaluating the effect of the endoscopic technique revealed a significant correlation with postoperative outcomes, particularly in terms of leg wound complications assessed by the ASEPSIS score (p < 0.001) and the prediction of postoperative NRS values for leg pain (p 0.001). Additionally, the impact on patients' quality of life across all subclinical categories was assessed using the Euro-Qol 5D (p < 0.001).

Conclusion: EVH presents itself as a viable minimally invasive alternative to traditional OVH techniques. It offers greater patient comfort, improved cosmetic satisfaction, a reduced incidence of postoperative leg wound complications, and lower levels of pain. Moreover, there is a statistically significant association between performing EVH techniques and enhanced quality of life, as well as a decrease in total ASEPSIS scores.