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J Thorac Cardiovasc Surg 2005;129:488-490
© 2005 The American Association for Thoracic Surgery

Editorials

Endoscopic saphenous vein harvesting: The good, the bad, and the ugly

Department of Cardiothoracic Surgery, Providence St Vincent Medical Center, Portland, Ore

Received for publication November 22, 2004; accepted for publication November 30, 2004.

^* Address for reprints: Anthony P. Furnary, MD, Department of Cardiothoracic Surgery, Starr-Wood Cardiac Group, 9155 SW Barnes Rd, #240, Portland, OR 97225-6029 (E-mail: tfurnary@starrwood.com).

The first 300 words of the full text of this article appear below.

In this issue of the Journal, Yun and colleagues¹ from Kaiser Permanente Medical Center in Los Angeles and Providence Health System present us with an excellent prospective randomized study comparing the midterm angiographic patency results between open saphenous vein harvesting and endoscopic vein harvesting (EVH). The study design is superb, the statistical analyses are impeccable, and the discussion is insightful and erudite. However, the clinical outcomes presented therein should have us all turning our heads and thinking further about how we do that thing we do on an almost daily basis: namely, coronary artery bypass surgery.

But which way should our heads be turning? As with many great articles, this one answers several important questions with regard to the efficacy and safety of EVH, but for me (and I suspect for many others out there), it raises a plethora of philosophical questions about the nature of that thing we do that have been left unanswered. Thus in my view these results, the questions they answer, and the contemplative ones they concomitantly raise can be summarized (with all due respect to Clint Eastwood, Lee Van Cleef, and Eli Wallach) as "The Good, The Bad, and The Ugly," with a new character thrown into the mix: "The Excellent."

	The good

 
EVH techniques are just as good as open harvesting techniques in terms of bypass graft patency. When evaluated by means of angiography at 6-month follow-up, there were no differences between the 2 techniques in overall patency, nor were there differences in the incidence of stenoses of patent vein grafts. Thus one can conclude that the use of EVH does not compromise midterm (6-month) vein graft patency.

EVH is good for the patient. The Yun study shows that EVH independently reduces leg wound complications by 67% compared with the open harvesting techniques. Furthermore, the . . . [Full Text of this Article]