The Verdict Is In: Endoscopic Vein-Graft Harvest Is as Safe as Open Harvest

A large contemporary, observational study allays concerns about long-term safety.

Endoscopic harvesting of veins for coronary artery bypass grafting (CABG) was considered a major advance because it results in better cosmetic appearance, less pain, and fewer infections than open vein-graft harvesting. However, a study published in 2009 raised questions about the long-term safety of endoscopic compared with open vein-graft harvesting (JW Cardiol Jul 15 2009). In response to these concerns, the FDA requested an analysis of data from the Society of Thoracic Surgeons national database. A cohort of 235,394 Medicare-eligible patients (mean age, 74) from 934 U.S. sites was compiled for the analysis.

Included were 122,899 endoscopic and 112,495 open vein-graft harvests. Baseline patient characteristics were generally similar between the treatment groups. During a median follow-up of 3 years, unadjusted cumulative mortality did not differ significantly between the endoscopic and open vein-graft harvest groups (13.2% and13.4%). Compared with open harvesting, endoscopic harvesting was associated with a significant 17% reduction in the rate of harvest site wound infection. Multiple sophisticated statistical analyses, including sensitivity and subpopulation analyses, confirmed the primary findings.

Citation(s):

Williams JB et al. Association between endoscopic vs open vein-graft harvesting and mortality, wound complications, and cardiovascular events in patients undergoing CABG surgery. JAMA 2012 Aug 1; 308:475.

Dacey LJ. Endoscopic vein-graft harvest is safe for CABG surgery. JAMA 2012 Aug 1; 308:512.