Influence of endoscopic versus traditional saphenectomy on event-free survival: five-year follow-up of a prospective randomized trial.

BACKGROUND Endoscopic harvesting of the greater saphenous vein is increasingly used during cardiac surgery to improve patient satisfaction and reduce the wound complications associated with traditional open techniques. Although histologic studies suggest no significant difference in vein quality between these two techniques, long-term follow-up is lacking to address whether graft patency and event-free survival are influenced by the harvest method. METHODS A total of 112 isolated coronary artery bypass patients were prospectively randomized to have veins harvested using either an endoscopic (n = 54) or traditional (n = 58) technique. Groups were demographically similar with regard to preoperative risk stratification and coronary procedures performed. Event-free survival (freedom from death, myocardial infarction, or recurrent angina) and use of outpatient resources for resolution of wound complications were determined. Follow-up was 100% at 5 years. RESULTS Five-year actual event-free survival was similar in patients with endoscopic versus traditionally harvested v e ins (75% versus 74%, P =.85). The number of outpatient office visits required to manage each wound complication to complete resolution was significantly less following endoscopic versus traditional vein harvest (1.5 versus 6 visits, P =.001). CONCLUSIONS Wound complication management following endoscopic versus traditional vein harvest requires less resource utilization. Five-year follow-up of a prospective randomized trial demonstrates that use of endosco pic versus traditionally harvested saphenous veins does not influence event-free survival.