Decreased patency rates following endoscopic vein harvest in coronary artery bypass surgery
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Synergizing Antegrade Endoscopic with Bridging Vein Harvesting for Improvement of Great Saphenous Vein Graft Quality from the Lower Leg
Published on: November 19, 2019
Insights
Endoscopic vein harvest (EVH) showed higher vein graft failure rates compared to open vein harvest (OVH) after 6.3 years. However, long-term clinical outcomes like angina, myocardial infarction, and mortality did not differ significantly between the two methods.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Minimally Invasive Surgery
Background:
- Endoscopic vein harvest (EVH) is increasingly used in coronary artery bypass grafting (CABG).
- Concerns exist regarding potential adverse mid- and long-term effects of EVH.
- Direct comparison of long-term clinical outcomes between EVH and open vein harvest (OVH) is crucial.
Purpose of the Study:
- To compare the long-term clinical outcomes of patients undergoing CABG using EVH versus OVH.
- To assess differences in vein graft failure, angina recurrence, myocardial infarction, and mortality.
Main Methods:
- A clinical follow-up study of 126 patients initially randomized to compare early leg wound complications.
- Included computed tomographic coronary angiography and retrospective follow-up of deceased patients.
- Median follow-up duration was 6.3 years.
Main Results:
- Vein graft failure was significantly higher in the EVH group (42%) compared to the OVH group (6%) (P = 0.001).
- No significant differences were observed in the recurrence of angina (P = 0.44).
- No significant differences were found in myocardial infarction (P = 0.11) or all-cause mortality (P = 0.15).
Conclusions:
- EVH is associated with a significantly higher rate of vein graft failure compared to OVH at a median follow-up of 6.3 years.
- Despite increased graft failure, EVH did not lead to significant differences in long-term clinical outcomes such as angina, myocardial infarction, or mortality.
Objectives:
Endoscopic vein harvest has gained widespread use in coronary artery bypass surgery. However, potential negative mid- and long-term effects following endoscopic vein harvest have been described. We aimed to compare long-term clinical outcomes following endoscopic and open vein graft harvesting.
Design:
This study was a clinical follow-up with additional computed tomographic coronary angiography among 126 first-time bypass patients originally included in a randomized study comparing early leg wound complications and cosmetic results. Deceased patients were retrospectively followed up.
Results:
Follow-up was complete, but information on clinical endpoints was not available in all patients. A total of 111 patients were alive at follow-up. Median observation time was 6.3 (range: 0.2–9.1) years including three in-hospital deaths. Vein graft failure was significantly higher in the endoscopic vein harvest (EVH) group (13 of 31; 42%) compared with the open vein harvest (OVH) group (2 of 32, 6%) (P = 0.001). However, this difference was not reflected by differences in recurrence of angina (P = 0.44), myocardial infarction (P = 0.11), and all-cause mortality (P = 0.15).
Conclusions:
Using a median follow-up time of 6.3 years significantly more vein graft failures were identified following EVH compared with OVH without any differences in long-term clinical outcomes.
