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Association between endoscopic vs open vein-graft harvesting and mortality, wound complications, and cardiovascular
Judson B Williams1, Eric D Peterson, J Matthew Brennan
1Duke Clinical Research Institute, Duke University Medical Center, Durham, NC 27710, USA.
Insights
Endoscopic vein-graft harvesting for coronary artery bypass graft (CABG) surgery shows similar long-term mortality compared to open harvesting. This method also resulted in fewer wound complications, offering a safe alternative for CABG patients.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Minimally Invasive Techniques
Background:
- Concerns exist regarding the safety and durability of endoscopic vein graft harvesting in coronary artery bypass graft (CABG) surgery.
- This study addresses questions about long-term outcomes comparing endoscopic and open vein graft harvesting methods.
Purpose of the Study:
- To compare the long-term outcomes of endoscopic versus open vein-graft harvesting in Medicare patients undergoing CABG surgery in the United States.
- Evaluate differences in mortality, wound complications, and composite outcomes.
Main Methods:
- An observational study analyzed 235,394 Medicare patients undergoing isolated CABG surgery from 2003-2008.
- Data from the Society of Thoracic Surgeons (STS) national database were linked to Medicare files for longitudinal follow-up (median 3 years).
- Propensity score adjustment was used to control for clinical characteristics.
Main Results:
- Endoscopic vein graft harvesting was used in 52% of patients.
- No significant differences in long-term all-cause mortality or composite outcomes (death, myocardial infarction, revascularization) were observed between endoscopic and open harvesting.
- Endoscopic harvesting was associated with significantly lower harvest site wound complications (adjusted HR, 0.83; P < .001).
Conclusions:
- Endoscopic vein graft harvesting is not associated with increased long-term mortality in patients undergoing CABG surgery.
- The findings support endoscopic vein graft harvesting as a safe alternative to open harvesting, with the benefit of reduced wound complications.
Context:
The safety and durability of endoscopic vein graft harvest in coronary artery bypass graft (CABG) surgery has recently been called into question.
Objective:
To compare the long-term outcomes of endoscopic vs open vein-graft harvesting for Medicare patients undergoing CABG surgery in the United States.
Design, Setting, And Patients:
An observational study of 235,394 Medicare patients undergoing isolated CABG surgery between 2003 and 2008 at 934 surgical centers participating in the Society of Thoracic Surgeons (STS) national database. The STS records were linked to Medicare files to allow longitudinal assessment (median 3-year follow-up) through December 31, 2008.
Main Outcome Measures:
All-cause mortality. Secondary outcome measures included wound complications and the composite of death, myocardial infarction, and revascularization.
Results:
Based on Medicare Part B coding, 52% of patients received endoscopic vein-graft harvesting during CABG surgery. After propensity score adjustment for clinical characteristics, there were no significant differences between long-term mortality rates (13.2% [12,429 events] vs 13.4% [13,096 events]) and the composite of death, myocardial infarction, and revascularization (19.5% [18,419 events] vs 19.7% [19,232 events]). Time-to-event analysis for those patients receiving endoscopic vs open vein-graft harvesting revealed adjusted hazard ratios [HRs] of 1.00 (95% CI, 0.97-1.04) for mortality and 1.00 (95% CI, 0.98-1.05) for the composite outcome. Endoscopic vein-graft harvesting was associated with lower harvest site wound complications relative to open vein-graft harvesting (3.0% [3654/122,899 events] vs 3.6% [4047/112,495 events]; adjusted HR, 0.83; 95% CI, 0.77-0.89; P < .001).
Conclusion:
Among patients undergoing CABG surgery, the use of endoscopic vein-graft harvesting compared with open vein-graft harvesting was not associated with increased mortality.
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