Minimally invasive vein harvesting for coronary bypass surgery offered in Johannesburg

Endoscopic harvesting technique enables patients to get back on their feet quicker

Tuesday, March 13 2018

Many patients suffering from severe coronary heart disease require coronary artery bypass surgery, which involves one or more arteries or veins being surgically transplanted. The transplanted artery or vein bypasses the diseased and blocked coronary artery and creates a new pathway to restore blood flow to the heart.

The cardiac centre at Netcare Union Hospital in Alberton now routinely uses minimally invasive endoscopic techniques to harvest veins for heart bypass surgery, which represents an important advancement in cardiovascular medicine for the region, said Jacques du Plessis, managing director of the Netcare hospital division today.

“This technique holds a number of advantages over open surgery techniques that are traditionally used for vein harvesting, including quicker healing and recovery times. These are important benefits for our patients,” adds Du Plessis.

“Endoscopic vein harvesting is now offered to appropriate patients at the multidisciplinary cardiac centre at Netcare Union Hospital by cardiothoracic surgeons, Dr Kaveer Sohan and his team, including fellow cardiothoracic surgeon Dr Jaco Botha. These highly trained specialists have extensive experience in the procedure, having completed more than 200,” adds Du Plessis.

Dr Sohan explains that coronary artery bypass involves harvesting a healthy artery or vein from elsewhere in the body, such as the leg, arm or chest, which is then grafted to the coronary artery during the bypass surgery.

An endoscopic procedure is when a doctor uses scoping technology and instruments to visualise and operate on the internal organs and vessels of the human body. It requires only small puncture wounds to the skin instead of large surgical incisions required in traditional open surgery.

Dr Sohan says that this approach to vein harvesting, which requires a small 3cm incision to be made just below the knee to insert the tubular scope, is not new, but it is highly intricate and requires a high degree of training, familiarity and experience to undertake successfully.

“In international experience, which has been confirmed at our practise, the endoscopic vein harvesting [EVH] technique is being shown to not only make it possible for patients to get back on their feet more quickly, but the smaller incisions tend to have less risk of wound complications and post-operative pain,” affirms Dr Sohan.

“Furthermore, this procedure is better from a cosmetic perspective, and it is easy to harvest more than one vein should more than one coronary artery be diseased and multiple blood vessels be required. We always try to do more than one arterial graft, as arterial grafts give an improved long-term outcome,” notes Dr Sohan.

“As a result of its advantages, the endoscopic vein harvesting technique is increasingly becoming the approach of choice for vein harvesting for bypass surgery around the world. Indeed, the International Society for Minimally Invasive Cardiothoracic Surgery [ISMICS] concluded back in 2005 that EVH should be the standard of care for vessel harvesting.”

In 2014, The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) provided a Class IIa indication for the procedure, which means that “[The] weight of evidence/opinion is in favour of usefulness/efficacy” and the procedure “should be considered”.

Dr Sohan explains that coronary artery disease is characterised by a waxy substance called plaque which builds up inside the coronary arteries, and can block and obstruct blood from pumping to the heart.

“In some cases these blockages can cause angina, which is a condition characterised by chest pain resulting from the heart muscle not getting sufficient oxygen-rich blood, or it may also cause a life-threatening heart attack or heart failure. Coronary artery bypass grafting surgery is an important treatment option for many such patients.”

“We are gratified that we can now offer EVH and its benefits routinely to those patients in whom it is identified as the safest and most appropriate option. Each case is carefully assessed to ascertain the best approach to harvesting, and we now use EVH in the great majority of cardiac bypass surgeries at the Netcare Union Hospital cardiac centre. We are planning to also offer endoscopic radial artery harvesting in the near future,” notes Dr Sohan.

Netcare Union Hospital general manager, Esme Abrahams, congratulated Dr Sohan and his team for introducing the option which will benefit many patients who require a coronary artery bypass grafting procedure.

“The multidisciplinary cardiac team at Netcare Union Hospital is constantly exploring pioneering new approaches to medicine to improve the lives of our patients.  This new approach to vein harvesting is further evidence of this,” she concludes.


Issued by: Martina Nicholson Associates (MNA) on behalf of Netcare Union Hospital
Contact: Martina Nicholson, Graeme Swinney, and Meggan Saville 
Telephone: (011) 469 3016
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