ABSTRACT
Background: We present our early experience of introducing state-of-the-art endoscopic vessel harvesting (EVH) into a hospital in Scotland. Coronary arteries bypass grafting (CABG) is the most frequently performed adult cardiac surgical operation and circa. 1200 cases were performed across Scotland in 2019/20, prior to the COVID-19 pandemic. Although internal thoracic artery (ITA) is the preferred conduit, most CABG operations require long saphenous vein (LSV) to be harvested from one or both legs. The radial artery (RA) is also used less frequently. Conduits are currently harvested by open technique, representing one of the longest incisions in surgery. Even when expertly performed, this is a major source of morbidity and delayed hospital discharge. Known risk factors for wound complications include age > 75 years, female sex, BMI > 28, history of smoking, diabetes mellitus and peripheral vascular disease. Both LSV and RA can be successfully harvested endoscopically via 2 cm incision with expected reduction in post-operative morbidity. In our quest to make CABG less invasive, we decided to embark upon a programme of EVH and hereby present our early clinical experience and vision for future roll-out across centres routinely performing cardiac surgery in Scotland. Methods: Consecutive patients undergoing isolated elective CABG surgery at one institution were consented for endoscopic vessel harvesting (EVH). We used a novel on-screen imaging (CoreVista, CardioPrecision), along with latest EVH harvesting tools (HemoPro 2, Getinge) and standard imaging/CO2 insufflation (Stryker). Data on risk factors, wound complications, patient satisfaction and length of stay were collected. Results: A short video will be used to demonstrate key steps of the procedure. Nine patients were recruited into the study. The mean age was 61 years [95% CI 53-69 years]. Six out of 9 (66%) patients had one or more risk factors for post-operative wound complications. LSV was harvested endoscopically in 6 patients (66%) and RA in 3 (33%) patients. The median number of grafts was 3 [range 2-5]. There were no immediate wound complications. All patients expressed a high level of satisfaction with the surgical result. Median post-operative length of stay was 5 days [range 5-6 days]. At a median follow-up of 2 months there were no late wound complication or adverse events reported. Conclusions: EVH was successfully delivered without complications in our series with high degree of patient satisfaction and consistently short length of stay. The combination of devices was easy to use and integrate into the standard CABG theatre footprint and procedure. Plans are now being made to implement EVH more widely across Scotland.