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Ann Thorac Surg 2010;90:1743. doi:10.1016/j.athoracsur.2010.04.094
© 2010 The Society of Thoracic Surgeons
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Correspondence

Endoscopic Vein Harvesting: Does the Learning Curve Influence Outcomes?

Bilal Kirmani, MRCS, Joseph Zacharias, FRCS (CTh)

Department of Cardiothoracic Surgery, Lancashire Cardiac Centre, Blackpool Victoria Hospital, Whinney Heys Rd, Blackpool FY3 8NR, United Kingdom

(Email: drjzacharias{at}gmail.com).

To the Editor:

We read with relief the recent observational study by Ouzounian and colleagues [1] comparing midterm outcomes of endoscopic (EVH) and open (OVH) vein harvest. The authors were prompted by the lack of robust evidence regarding the longevity of endoscopically harvested conduit and the recent publication of a subgroup analysis of patients in the Project of Ex-vivo Vein Graft Engineering via Transfection (PREVENT) IV trial by Lopes and colleagues [2]. To support continued use of minimally invasive harvesting techniques at our center, we conducted a study of our own 3-year data to scrutinize local outcomes and mortality. We included all patients from our very first procedure to look at the possible effect of a learning curve.

Our single-center, single-surgeon retrospective case-control study of 271 patients (89 EVH, 182 OVH) did not demonstrate any inferiority of EVH compared with OVH at a median follow-up of 17 months. Our patients were well matched demographically, although there was a higher rate of left main stem disease and left ventricular dysfunction in the EVH group. Midterm mortality was 2 of 89 (2%) in the EVH group and 8 of 182 (4%) in the OVH group (p = 0.65), with no difference in freedom from angina (p > 0.99), readmission (p = 0.78), or need for further antianginal therapy (p > 0.99). The EVH group, as expected, benefitted from a reduced leg wound complication rate (7% vs 28%, p = 0.0008) and reported higher patient satisfaction scores (p = 0.06). Both deaths in the EVH group were of cancer-related causes.

This review of our own performance, especially in light of the similar findings of the report by Ouzounian and colleagues, has helped justify continuing with minimally invasive techniques of vein harvest in our unit. Although there is an obvious learning curve associated with increased time taken to harvest conduit [3], we found no detriment to midterm results for our early patients. We hope that this finding will be substantiated in future prospective randomized controlled trials that are now long overdue.


   References
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 References
 

  1. Ouzounian M, Hassan A, Buth KJ, et al. Impact of endoscopic versus open saphenous vein harvest techniques on outcomes after coronary artery bypass grafting Ann Thorac Surg 2010;89:403-408.[Abstract/Free Full Text]
  2. Lopes RD, Hafley GE, Allen KB, et al. Endoscopic versus open vein-graft harvesting in coronary-artery bypass surgery N Engl J Med 2009;361:235-244.[Medline]
  3. Waqar-Uddin Z, Purohit M, Blakeman N, Zacharias J. A prospective audit of endoscopic vein harvesting for coronary artery bypass surgery Ann R Coll Surg Engl 2009;91:426-429.[Medline]



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M. Ouzounian, K. J. Buth, and I. S. Ali
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Ann. Thorac. Surg., November 1, 2010; 90(5): 1743 - 1743.
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