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J Thorac Cardiovasc Surg 2004;127:1402-1407
© 2004 The American Association for Thoracic Surgery

Surgery for acquired cardiovascular disease

Early quantitative coronary angiography of saphenous vein grafts for coronary artery bypass grafting harvested by means of open versus endoscopic saphenectomy: A prospective randomized trial

L.P. Perrault, MD, PhDa,b,c,*, H. Jeanmart, MDa,b, L. Bilodeau, MDd, J. Lespérance, MDe, J.-F. Tanguay, MDd, D. Bouchard, MDa,b, P. Pagé, MDa,b, M. Carrier, MDa,b

a Research Center, Montreal Heart Institute and University of Montreal, Montreal, Quebec, Canada
b Department of Surgery, Montreal Heart Institute and University of Montreal, Montreal, Quebec, Canada
c Department of Pharmacology, Montreal Heart Institute and University of Montreal, Montreal, Quebec, Canada
d Department ofCardiology, Montreal Heart Institute and University of Montreal, Montreal, Quebec, Canada
e Department of Radiology, Montreal Heart Institute and University of Montreal, Montreal, Quebec, Canada

Received for publication June 26, 2003; revisions received October 9, 2003; accepted for publication October 23, 2003.

* Address for reprints: L. P. Perrault, MD, PhD, Research Center, Montreal Heart Institute, 5000 Belanger Street East, Montreal, Quebec H1T 1C8, Canada
lpperrau{at}icm.umontreal.ca

OBJECTIVE: Endoscopic saphenectomy is associated with a decreased incidence of wound complications without an increase in histologic trauma or endothelial dysfunction in published reports. Concern remains about the patency of saphenous vein grafts harvested endoscopically and the development of early intimal hyperplasia. The purpose of this study was to compare early quantitative coronary analysis of saphenous vein grafts used for coronary artery bypass grafting harvested with the open versus endoscopic techniques.

METHODS: Forty patients undergoing primary coronary artery bypass grafting surgery with at least 1 saphenous vein graft were randomized preoperatively to open versus endoscopic saphenectomy with bipolar cauterization of side branches. Quantitative coronary angiography was performed a mean of 3 months (range, 1-9 months) after the operation.

RESULTS: There was no statistically significant difference in the patency rates of internal thoracic artery grafts between the open and endoscopic groups and no statistically significant difference in the patency rates of saphenous vein grafts between both groups (85.2% vs 84.4%, P = .991). Quantitative coronary angiography showed no difference in graft stenosis (>=50% of the internal diameter of the graft) in the body of the saphenous vein grafts in the open versus endoscopic saphenectomy groups (3.7% vs 0%, P = .280).

CONCLUSION: Angiographic appearance and patency rates of saphenous vein grafts harvested with the endoscopic technique are similar to those of saphenous vein grafts harvested with the open technique. These results support the use of endoscopic saphenectomy because of the known lower incidence of wound and infectious complications and superior functional results.




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