Minimally Invasive Direct Vision versus Conventional Open Saphenous Vein Harvesting
Teerapong Tocharoenchok MD*, Ruchira Ruangchira-urai MD**, Somchai Sriyoschati MD*, Thaworn Subtaweesin MD*, Kriangkrai Tantiwongkosri MD*
Affiliation : * Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand ** Department of Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Background : Minimally invasive direct vision saphenous vein graft harvesting for coronary artery bypass graft may reduce
donor site wound complications compared with conventional open techniques.
Objective : This study compared the integrity of saphenous vein grafts harvested by minimally invasive direct vision versus
the conventional open technique, and donor site wound complications between groups.
Material and Method: The authors included 50 patients from 419 patients undergoing coronary artery bypass grafting from
October 2012 to August 2013; 25 received minimally invasive direct vision harvesting. Venous graft integrity was assessed
macroscopically by the number of repaired branch avulsions and microscopically by evaluation of percentage of existing
endothelial cells using Cluster of Differentiation 31 immunohistochemical stain. Venous integrity and donor wound complications
in both groups were compared at the time of operation and 1 month post-coronary artery bypass grafting.
Results : Conventional open patients had lower left ventricular ejection fraction, greater number of diabetes mellitus cases,
shorter operative time, shorter graft harvesting time, and longer cumulative incision length. The numbers of repaired branch
avulsions and microscopic existence of vascular endothelial cell lining were comparable in both groups. First 72-hour pain
scores, and overall donor wound complications were similar. However, wound ecchymosis was more prevalent in the
minimally invasive group. Thigh vein harvesting was associated with vein graft injury. Venous branch avulsion predicted
donor site wound ecchymosis.
Conclusion : Integrity of saphenous vein graft harvested by minimally invasive direct vision was comparable with that of
conventional open technique. Donor wound complications were similar in both groups and thigh vein harvesting was
associated with venous branch avulsion.
Keywords : CABG, Venous grafts, Surgery/incisions/exposure/techniques, Complications
