Minimally invasive direct vision versus conventional open saphenous vein harvesting

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.