Aug 2 2012
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.
Licensed from medwireNews with permission from Springer Healthcare Ltd. ©Springer Healthcare Ltd. All rights reserved. Neither of these parties endorse or recommend any commercial products, services, or equipment.