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Bitter Harvest?

Disturbing long-term observational results suggest that endoscopic vein harvesting for CABG increases the risk for several adverse outcomes.

Endoscopic harvesting of veins for coronary artery bypass grafting has become popular because it reduces the risks for wound infection and postoperative pain compared with vein harvesting under direct vision (open harvesting). However, the long-term effects of endoscopic harvesting on angiographic and clinical outcomes are unknown. The Project of Ex-vivo Vein Graft Engineering via Transfection IV (PREVENT IV) trial included 3014 CABG recipients; patients' median age was 64, and almost 80% were men. Individual surgeons decided which vein harvesting method to use; 1753 patients underwent endoscopic harvesting, and 1247 underwent open harvesting.

Results of angiographic assessment 12 to 18 months after surgery were available for 1817 participants. Vein graft failure, defined as stenosis of 75% of the vessel diameter, occurred more frequently in patients who underwent endoscopic harvesting than in those who underwent open harvesting (46.7% vs. 38.0%; adjusted odds ratio, 1.45; 95% confidence interval, 1.20–1.76). At 3-year clinical follow-up, those who underwent endoscopic harvesting also had a higher rate of the composite of death, MI, and revascularization (20.2% vs. 17.4%; adjusted hazard ratio, 1.22; 95% CI, 1.01–1.47) and a higher rate of the composite of death and MI (9.3% vs. 7.6%; adjusted HR, 1.38; 95% CI, 1.07–1.77).

Comment: This well-done observational study raises important concerns about the use of endoscopic vein harvesting. The short-term benefits might be outweighed by longer-term risks. The decision about the best way to harvest veins for CABG has just gotten a lot more complicated.

— Harlan M. Krumholz, MD, SM

Published in Journal Watch Cardiology July 15, 2009

Citation(s):

Lopes RD et al. Endoscopic versus open vein-graft harvesting in coronary-artery bypass surgery. N Engl J Med 2009 Jul 16; 361:235.

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• vein harvesting
  guy g lemire, 21 Jul 2009 5:42 PM EST
  with 35 years experience doing coronary bypass surgery and the last 5 years using endoscopic techniques,i am not surprised by... [more]