To create the bypass graft, a surgeon will remove or "harvest" healthy blood vessels from another part of the body, either arteries from an arm or the chest, or veins from a leg.
In clinical studies, EVH has shown important benefits, including a reduced risk of infection[3][4] and wound complications;[3][5][6][7][8][9][10][11][12][13][14] less postoperative pain and swelling;[5][15][16] and faster recovery[8][11][17][18][19] with minimal scarring.
[16][17] The reduction in pain allows patients to get back on their feet and return to normal mobility much sooner,[11][17][18][19] and have a reduced length of hospital stay.
However, a 2009 study published by Dr. Renato Lopes et al. in the New England Journal of Medicine concluded that the clinical outcomes of EVH were inferior to open vessel harvesting (OVH),[22] prompting a flurry of articles in mainstream media.
[27] The study compared more than 8,500 propensity-adjusted patients and revealed that EVH significantly reduced wound complications without compromising long-term survival or freedom from repeat revascularization.
[28][29] Totaling more than 16,000 patients tracked, these three studies provide strong evidence that EVH is a safe and viable technique to use to obtain a saphenous vein conduit for CABG surgery.
Additional support that EVH does not adversely affect the integrity of the conduit and has equivalent clinical outcomes has recently been published by Krishnamoorthy et al. in Circulation.
[30] As mentioned above, the success of CABG surgery may be influenced by the quality of the "conduit" vessel and how it is handled or treated during the harvest and preparation steps prior to grafting.
The harvested blood vessel used in coronary artery bypass graft surgery must be free from damage to ensure proper long-term function and good patient outcomes.
[32][33] Specifically, damage can be caused during the procedure by: To preserve and optimize conduit quality, clinical specialists take care to avoid unnecessary thermal injury, overhandling and overdistension, and ensure proper storage conditions for the harvested vessel.
Thermal Injury Comprehensive training and a careful approach are needed when cutting and removing side branches from the main vessel being harvested.
There are two main forms of electrical energy used for cutting and sealing off branch vessels during harvesting: bipolar radio frequency (RF) and direct current (DC).