Based on Medicare Part B coding, 52 percent of patients received endoscopic vein-graft harvesting during CABG surgery. The researchers found no significant differences between the cumulative incidence rate for mortality through 3 years for the endoscopic (13.2 percent [12,429 events]) and open (13.4 percent [13,096 events]) vein-graft harvest groups. There were also no significant differences between the cumulative incidence through 3 years for the composite of death, heart attack, or revascularization among the endoscopic vs. open vein-graft harvest groups (19.5 percent [18,419 events] vs. 19.7 percent [19,232 events]).
Endoscopic vein-graft harvesting was associated with lower harvest site wound complications relative to open vein-graft harvesting (3.0 percent vs. 3.6 percent).
"Our study found that endoscopic vein-graft harvesting was the most commonly used technique for vein-graft harvesting, with approximately 70 percent of CABG surgery cases in the STS Adult Cardiac Surgery Database using this technique in 2008, the most recent year examined. After adjustment for baseline clinical factors, no evidence was found of increased long-term mortality or the composite of death, myocardial infarction, or revascularization associated with endoscopic vs. open vein-graft harvesting in isolated patients undergoing CABG surgery. Consistent with previous randomized comparisons, use of endoscopic vein-graft harvesting was associated with a significant reduction in wound complications relative to the open procedures," the authors conclude.
In an accompanying editorial, Lawrence Dacey, MD, MS, of the Dartmouth-Hitchcock Medical Center, Lebanon, N.H., comments on the findings of this study.
"Physicians tend to do what is best for their patients. Patient satisfaction is markedly better with endoscopic vein-graft harvesting. Patients who have had both an endoscopic and open vein-graft harvest marvel at the difference in reduced pain and time of healing with endoscopic vein-graft harvesting. This conclusive study by Williams et al provides information to say with certainty that the benefits of endoscopic vein-graft harvesting in short-term patient-centered outcomes are not associated with an increased risk of important adverse long-term outcomes. And that is something to be thankful for."
