In the Journals

No evidence of long-term increased risk for death with endoscopic vein graft harvesting

An analysis of data from more than 200,000 patients who underwent CABG surgery from 2003 to 2008 found no evidence of a long-term increased mortality risk with endoscopic vein-graft harvesting as compared with open vein-graft harvesting.

The safety of the endoscopic vein-graft harvesting technique was called into question after the 2009 publication of a study of 3,000 patients who received this procedure demonstrated higher 3-year mortality than those who received the open vein-graft harvesting.

To examine the safety of the two techniques, Judson B. Williams, MD, MHS, of Duke University Medical Center, and colleagues conducted a FDA-sponsored, observational study of 235,394 Medicare patients who underwent CABG at 934 surgical centers participating in the Society of Thoracic Surgeons (STS) national database. About half (52%) were endoscopic cases, according to a press release.

Similar findings, some benefit noted

Researchers found no significant differences between the cumulative incidence rate for mortality through 3 years for patients who underwent endoscopic (13.2%; 12,429 events) and open (13.4%; 13,096 events) vein-graft harvest. There was also no significant difference in the cumulative incidence rate for the composite of death, MI or revascularization through 3 years for the two groups (endoscopic: 19.5%; 18,419 events vs. open: 19.7%; n=19,232 events).

The endoscopic technique was, however, associated with a significant reduction in wound complications relative to open vein-graft harvesting (3%; 3,654 events vs. 3.6%; 4,047 events).

Results also revealed that endoscopic vein-graft harvesting was the most commonly used technique for vein-graft harvesting. In 2008, approximately 70% of CABG cases used this technique.

“Our results do not suggest an associated survival advantage with endoscopic vein-graft harvesting. … (Rather), our analysis did not identify harm associated with endoscopic vein-graft harvesting,” Williams and colleagues said.

Benefits and patient satisfaction

Lawrence J. Dacey, MD, MS

Lawrence J. Dacey

In an accompanying editorial, Lawrence J. Dacey, MD, MS, of the Dartmouth-Hitchcock Medical Center, Lebanon, N.H., said: “Physicians tend to do what is best for their patients. Patient satisfaction is markedly better with endoscopic vein-graft harvesting. Patients who have had both an endoscopic and open vein-graft harvest marvel at the difference in reduced pain and time of healing with endoscopic vein-graft harvesting. This conclusive study by Williams et al provides information to say with certainty that the benefits of endoscopic vein-graft harvesting in short-term patient-centered outcomes are not associated with an increased risk of important adverse long-term outcomes. And that is something to be thankful for.”

For more information:

Dacey LJ. JAMA. 2012;308:512-513.

Williams JB. JAMA. 2012;308:475-484.

Disclosure: Drs. Dacey and Williams report no relevant financial disclosures.

An analysis of data from more than 200,000 patients who underwent CABG surgery from 2003 to 2008 found no evidence of a long-term increased mortality risk with endoscopic vein-graft harvesting as compared with open vein-graft harvesting.

The safety of the endoscopic vein-graft harvesting technique was called into question after the 2009 publication of a study of 3,000 patients who received this procedure demonstrated higher 3-year mortality than those who received the open vein-graft harvesting.

To examine the safety of the two techniques, Judson B. Williams, MD, MHS, of Duke University Medical Center, and colleagues conducted a FDA-sponsored, observational study of 235,394 Medicare patients who underwent CABG at 934 surgical centers participating in the Society of Thoracic Surgeons (STS) national database. About half (52%) were endoscopic cases, according to a press release.

Similar findings, some benefit noted

Researchers found no significant differences between the cumulative incidence rate for mortality through 3 years for patients who underwent endoscopic (13.2%; 12,429 events) and open (13.4%; 13,096 events) vein-graft harvest. There was also no significant difference in the cumulative incidence rate for the composite of death, MI or revascularization through 3 years for the two groups (endoscopic: 19.5%; 18,419 events vs. open: 19.7%; n=19,232 events).

The endoscopic technique was, however, associated with a significant reduction in wound complications relative to open vein-graft harvesting (3%; 3,654 events vs. 3.6%; 4,047 events).

Results also revealed that endoscopic vein-graft harvesting was the most commonly used technique for vein-graft harvesting. In 2008, approximately 70% of CABG cases used this technique.

“Our results do not suggest an associated survival advantage with endoscopic vein-graft harvesting. … (Rather), our analysis did not identify harm associated with endoscopic vein-graft harvesting,” Williams and colleagues said.

Benefits and patient satisfaction

Lawrence J. Dacey, MD, MS

Lawrence J. Dacey

In an accompanying editorial, Lawrence J. Dacey, MD, MS, of the Dartmouth-Hitchcock Medical Center, Lebanon, N.H., said: “Physicians tend to do what is best for their patients. Patient satisfaction is markedly better with endoscopic vein-graft harvesting. Patients who have had both an endoscopic and open vein-graft harvest marvel at the difference in reduced pain and time of healing with endoscopic vein-graft harvesting. This conclusive study by Williams et al provides information to say with certainty that the benefits of endoscopic vein-graft harvesting in short-term patient-centered outcomes are not associated with an increased risk of important adverse long-term outcomes. And that is something to be thankful for.”

For more information:

Dacey LJ. JAMA. 2012;308:512-513.

Williams JB. JAMA. 2012;308:475-484.

Disclosure: Drs. Dacey and Williams report no relevant financial disclosures.