Successful establishment of EVH at Munich hospital
At the Ludwig-Maximilians-University (LMU) hospital in Munich, Germany, Endoscopic Vessel Harvesting (EVH) for bypass surgery has been carried out since 2020. Today, the therapy is used on almost 90 percent of Coronary Artery Bypass Grafting (CABG) patients, regardless of age and extent of the cardiac disease.
“In our clinic, around 550 isolated or combined bypass surgeries are performed every year. We now remove the necessary vessels completely endoscopically from almost 90 percent of patients, regardless of age and extent of the disease,” reports Prof. Dr. Christian Hagl, Head of the Cardiac Surgery Clinic.
Two years after implementing EVH, the hospital has been able to operate on more than 400 patients, despite challenges that came with COVID-19. In contrast to conventional open vessel harvesting, which is accompanied by a long incision usually over the entire leg and/or the entire forearm of the patient, EVH allows the radial artery in the arm and/or the greater saphenous vein in the leg to be removed endoscopically through a small incision.
"According to the guidelines, endoscopic graft removal is recommended because, among other things, it is associated with a significant reduction in wound healing disorders and complications and is also less traumatic," explains Prof. Hagl.
Dr. Polyxeni Vlachea, resident and head of the EVH project at the LMU Klinikum, agrees:
“Compared to conventional removal or the often used bridge technique, EVH gives you very good magnification and visualization and you can prepare every branch precisely. As a result, the primary quality of the graft can be preserved much better.”
Not only are the users at the LMU Klinikum convinced about the therapy, but also the patients. Postoperatively, they benefit from fewer wound healing disorders, less pain, faster mobilization and smaller scars. Dr Vlachea is happy about the good results:
"During the removal, the legs can be largely spared, the blood loss is less, and hematomas are almost completely avoided. Since the incision does not go beyond the knee, patients experience significantly less pain and fewer neurological problems. The wounds heal much faster and the patients can be mobilized more quickly. After just 6-7 days, they are generally fit again.”
For Prof. Hagl, the avoidance of a wound healing disorder must be the highest priority for every patient.
“It is impressive to see that there are significantly fewer sensory disturbances in the area of the forearm due to the endoscopic removal of the radial artery. We rarely see numbness in the thumb. Cosmetic aspects also play a role by avoiding scars up to 30 centimeters long on the forearm”.
Implementing EVH took the staff six months, and many factors contributed to the success of the project.
“An excellent device and comprehensive support are prerequisites for good quality. Getinge has set up a full concept in an exemplary manner. We were thus able to develop a program together and Getinge supported us in an impressive way. We are more than satisfied,” says Prof. Hagl.
Going forward, the goal for this hospital is to reach the level where EVH is used in 100 percent of CABG cases.