Association Between Endoscopic vs. Open Vein-Graft Harvesting and Mortality, Wound Complications, and Cardiovascular Events in Patients Undergoing CABG Surgery

Study Questions:

What are the long-term outcomes of endoscopic versus open vein-graft harvesting for Medicare patients undergoing coronary artery bypass graft (CABG) surgery in the United States?

Methods:

This was an observational study of 235,394 Medicare patients undergoing isolated CABG surgery between 2003 and 2008, at 934 surgical centers participating in the Society of Thoracic Surgeons (STS) national database. The STS records were linked to Medicare files to allow longitudinal assessment (median 3-year follow-up) through December 31, 2008. The main outcome measure was all-cause mortality. Secondary outcome measures included wound complications and the composite of death, myocardial infarction, and revascularization. The differences between treatment groups in long-term all-cause mortality and the composite of death, myocardial infarction, and revascularization were compared with time-to-event analyses.

Results:

Based on Medicare Part B coding, 52% of patients received endoscopic vein-graft harvesting during CABG surgery. After propensity score adjustment for clinical characteristics, there were no significant differences between long-term mortality rate (13.2% [12,429 events] vs. 13.4% [13,096 events]) and the composite of death, myocardial infarction, and revascularization (19.5% [18,419 events] vs. 19.7% [19,232 events]). Time-to-event analysis for those patients receiving endoscopic versus open vein-graft harvesting revealed adjusted hazard ratios [HRs] of 1.00 (95% confidence interval [CI], 0.97-1.04) for mortality and 1.00 (95% CI, 0.98-1.05) for the composite outcome. Endoscopic vein-graft harvesting was associated with lower harvest site wound complications relative to open vein-graft harvesting (3.0% [3,654/122,899 events] vs. 3.6% [4,047/112,495 events]; adjusted HR, 0.83; 95% CI, 0.77-0.89; p < 0.001).

Conclusions:

The authors concluded that the use of endoscopic vein-graft harvesting compared with open vein-graft harvesting was not associated with increased mortality.

Perspective:

This nationally representative observational comparison of the long-term outcomes of endoscopic vein-graft harvesting technique in CABG surgery reports that after adjustment for baseline clinical factors, there was no increase in long-term mortality or the composite of death, myocardial infarction, or revascularization associated with endoscopic versus open vein-graft harvesting in 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 significant and consistent finding of an association of endoscopic vein-graft harvesting with improved wound complications, confirmed by multiple randomized studies, and no increase in adverse long-term outcomes, may make this the preferred approach for most patients.

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention

Keywords: Medicare Part B, Myocardial Infarction, Tissue and Organ Harvesting, Cardiovascular Diseases, Endoscopy, Confidence Intervals, Databases, Factual, Coronary Artery Bypass, Vascular Surgical Procedures, United States


< Back to Listings