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
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.