The Impact of Endoscopic Vein Harvest by Less Experienced Operators on Conduit Quality and Early Graft Patency

Objective: The saphenous-vein graft (SVG) is a key graft commonly used in coronary-artery bypass grafting (CABG), and its quality affects postoperative outcomes. endoscopic vein harvest (EVH) is an effective technique for wound healing and prevention of infection, but there is a learning curve, and there is no established assessment of how harvesting by a novice surgeon affects the patient's postoperative outcome. In this study, we investigated the effect of graft harvesting proficiency on the outcome of postoperative CABG patients. Methods: From 2005 to 2017, the patients who completed EVH were included in the analysis. Propensity score-matched EVH-experienced surgeon group and novice surgeon group, respectively, were compared for the graft patency and major adverse cardiac and cerebrovascular events (MACCE) extending into the remote phase. Results: A total of 719 patients underwent either isolated or combined CABG at the two institutions, and of those, the 173 patients with SVG harvested by EVH were divided into 60 Propensity score-matched groups, respectively. SVG occlusion in early postoperative period was 3 (5%) in group of novice surgeons (group A) and 6 (10%) in group of experienced surgeons (group B) (P=0.355). Similarly, there were 5 cases (8.3%) in group A and 1 case (1.7%) in group B for SVG stenosis (P = 0.272). Inpatient surgical mortality, 30-day mortality and 30-day in-hospital deaths were 1.7 % (Group A) vs 0 % (Group B) (P = 1.0). MACCE free rate of 1-, 3-, and 5-year was 96.4%/90.7%/90.7% vs. 96%/91.3%/84.8% (P = 0.175) (Group A vs. Group B), respectively. Conclusions: Among the patients undergoing CABG with EVH, a significant difference was not found between the surgeons of novice vein-graft harvesting and experienced in the risk of graft occlusion and major adverse cardiac events.