Endoscopic vs. Open Vein-Graft Harvesting in CABG: Is There a Difference?

No significant difference in mortality is associated with endoscopic vein-graft harvesting compared to open vein-graft harvesting in patients undergoing coronary artery bypass graft (CABG) surgery, according to a study released on July 31 in The Journal of the American Medical Association.


Previous smaller studies had indicated an increased risk of mortality associated with use of endoscopic vein-graft harvesting, prompting the the U.S. Food and Drug Administration to request further analysis of the two harvesting procedures. This new study, which uses data from The Society of Thoracic Surgeons Adult Cardiac Surgery Database (ACSD), found "no significant differences" between the two procedures in terms of long-term mortality rates (13.2 percent [12,429 events] vs. 13.4 percent [13,096 events]) and the composite of death, myocardial infarction and revascularization (19.5 percent [18,419 events] vs. 19.7 percent [19,232 events]). It also found that endoscopic vein-graft harvesting was associated with significantly reduced wound complications relative to the open procedures (risk adjusted HR, 0.83; 95 percent CI, 0.77-0.89).

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The study looked at 235,394 Medicare patients undergoing isolated CABG surgery between 2003 and 2008 at 934 surgical centers. Of those patients, endoscopic vein-graft harvesting was the most commonly used technique for vein-graft harvesting, with approximately 70 percent of CABG surgery cases in the ACSD using this technique in 2008. This study is more definitive than previous studies due to size and statistical power, and represents a more accurate picture of contemporary CABG surgery in the U.S., said Lawrence J. Dacey, MD, MS, from the Department of Cardiothoracic Surgery, Dartmouth-Hitchcock Medical Center in Lebanon, NH, in an editorial comment.

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