Patients prefer endoscopic harvest

Studies show less pain, less scarring

Researchers in a study led by Marc Gerdisch, MD, a cardiovascular surgeon on the staff of Central DuPage Hospital in Winfield, IL, found that patients who undergo endoscopic harvesting report significantly less pain than as patients treated with more traditional techniques.1 "We found that patients were very satisfied with their outcomes, not only because of the lack of leg pain, but for cosmetic reasons as well," Gerdisch writes. "They are able to resume full activity sooner and, without leg scars, there is little evidence they have undergone major surgery."

Data from 394 patients undergoing endoscopic harvesting were compared to that of 191 traditional patients. Closure times were significantly reduced in the endoscopic group although total skin-to-skin operating times for the entire procedure did not differ. Leg infection rates and other morbidities were lower, hospital readmissions for leg wound care were low, office visits required for leg care were lower, and pain perception was less.

A previous study by the researchers involved 209 heart bypass patients — 110 who had the endoscopic vein harvesting procedure and 99 who underwent the traditional open leg procedure.2 That study also concluded that the technique is safe, effective, and less painful.

More than 70% of all the patients who undergo CABG can be candidates for endoscopic harvesting. But, says Michael Bowen, PA, RN, administrative director of the department of surgery at Jewish Hospital in Cincinnati, the procedure is especially suited for patients who are debilitated. "It’s the surgeon’s preference of course, but diabetics are ideal candidates," he explains. "Since their tissue doesn’t heal well, the smaller the incisions, the faster they’ll heal and with fewer complications."

The harvesting is done toward the beginning of the cardiac grafting procedure. "By the time the surgeon is ready to perform the anastomosis of vessels, the vein has to be ready for use," he says.

Although veins typically are taken from patients’ legs for use in heart bypass surgery, Jewish Hospital has tried harvesting radial arteries from patients’ arms instead and found that the implanted artery stays open longer than a vein from the leg. "Patients seem to feel less post-op discomfort in their arms than in legs probably because legs are weight-bearing," says Bowen.

References

1. Davis Z, Gerdisch M, Jacobs H, et al. Endoscopic vein harvest for coronary artery bypass surgery. Presented at XIII World Congress of Cardiology, April 1998.

2. Davis Z, Jacobs H, Zhang M, et al. Endoscopic vein harvest for coronary artery bypass grafting: Technique and outcomes. J Thorac Cardiovasc Surg 1998; 116:228-235.