Demise of Open Vein Harvesting

In the course of a recent reoperative median sternotomy for aortic valve replacement in a patient who had a previous quadruple coronary artery bypass graft surgery, an injury to one of the previously placed vein grafts occurred. We needed to repair this injury with an interposition vein graft. The physician assistant (PA) assigned to the case was asked to harvest a short section of the greater saphenous vein. Because of the urgency of the situation, an open vein harvest (OVH) was thought to be the quickest way. The PA looked at me speechless with a great deal of apprehension. She stated that she had never seen an OVH, let alone done one before. An OVH was performed with the help of another PA.Article see p 147Reflecting back on this incident, it is apparent that endoscopic vein harvest (EVH) has become well established at the Brigham and Women's Hospital. Currently, >95% of veins are harvested endoscopically. More important, our PAs, who do all of the vein harvesting, are so experienced in this method that it takes less time than OVH. In addition, all our recent PA graduates can do only EVH. Currently, 5 of 9 PAs at our unit have never performed OVH.This incident, along with the study from the Northern New England Cardio Vascular Disease Study Group published in this issue of Circulation ,1 led us to conclude that EVH is here to …