While no significant difference in overall risk of major adverse cardiac events (MACE) was observed in patients undergoing coronary-artery bypass grafting (CABG) with either open or endoscopic vein-graft harvesting, a trend towards lower rates of individual cardiac events using endoscopic-harvesting was observed. Findings from the REGROUP study were presented Nov. 11 at AHA 2018 in Chicago, IL and simultaneously published in the New England Journal of Medicine.

A total of 1,150 patients undergoing CABG at 16 Veterans Affairs cardiac surgery centers were randomized to either open or endoscopic vein-graft harvesting performed by operators with documented experience. Groups were balanced in terms of age, sex, smoking status, race or ethnicity, body-mass index and coexisting conditions. Of note, 95.5 percent of total patients were male. The primary outcome was a composite of MACE. Researchers led by Marco A. Zenati, MD, also evaluated leg-wound complications. Median follow-up was 2.78 years.

Overall, the primary outcome occurred in 89 patients (15.5 percent) in the open-harvest group compared with 80 patients (13.9 percent) in the endoscopic-harvest group. Broken down by event, however, researchers noted a trend toward lower rates of MACE in the endoscopic-harvest group. Specifically, a total of 46 patients (8.0 percent) in the open-harvest group and 37 patients (6.4 percent) in the endoscopic-harvest group died; 34 patients (5.9 percent) in the open-harvest group compared with 27 patients (4.7 percent) in the endoscopic-harvest group experienced myocardial infarctions; and 35 patients (6.1 percent) in the open-harvest group compared with 31 patients (5.4 percent) in the endoscopic-harvest group underwent revascularization. Leg would infections were higher in the open-harvest group (18 patients/3.1 percent) compared with the endoscopic-harvest group (8 patients/1.4 percent).

In other findings, Zenati and colleagues noted that better harvest-site healing was observed in the endoscopic-harvesting group compared with the open-harvest group – a finding consistent with previous studies. They also suggest that that longer-term follow-up will be necessary to explore whether observed trends are persistent. Additionally, they highlight the need for further studies "to establish standards for harvester expertise to ensure the safety of patients and effectiveness of the procedure."

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention

Keywords: AHA18, AHA Annual Scientific Sessions, Coronary Artery Bypass, Tissue and Organ Harvesting, Endoscopy

< Back to Listings