Endoscopic vein grafts just as lifesaving as open-vein grafts

By Piriya Mahendra

Endoscopic vein-graft harvesting is not associated with higher mortality than open vein-graft harvesting, contrary to previous reports, researchers claim.

Peter Smith (Duke University, Durham, North Carolina, USA) and team found that after propensity score adjustment for clinical characteristics, 3-year mortality did not significantly differ between patients who underwent endoscopic vein-graft harvesting during coronary artery bypass graft (CABG) surgery compared with those who received open-vein grafts.

Furthermore, there was no significant difference among the groups in the composite of death, myocardial infarction, and revascularization at 3 years.

Time-to-event analysis demonstrated that the risk-adjusted hazard ratios for 3-year mortality and for the 3-year composite outcome were both 1.00 for endoscopic versus open vein-graft harvesting.

Patients who underwent endoscopic vein-graft harvesting had a significant 13% lower rate of wound complications than those who underwent open vein-graft harvesting (p<0.001).

The study included 235,394 Medicare patients who underwent isolated CABG surgery between 2003 and 2008. The endoscopic approach was the most commonly used technique for vein-graft harvesting, being used in approximately 70% of the CABG cases in 2008.

The findings of the study are in stark contrast to that of one published in 2009, which showed that patients who underwent endoscopic vein-graft harvesting had a higher 3-year mortality than those who underwent the open vein-graft technique.

In an accompanying editorial, Lawrence Dacey (Dartmouth-Hitchcock Medical Center, New Hampshire, USA) notes: "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."

He remarks that the study by Smith et al allows physicians to say "with certainty" that endoscopic vein-graft harvesting is not associated with an increased risk for adverse outcomes.

"And that is something to be thankful for," Dacey adds.

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