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.
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.