Randomized trial of endoscopic or open vein-graft harvesting for coronary-artery bypass

Marco A. Zenati, Deepak L. Bhatt, Faisal G. Bakaeen, Eileen M. Stock, Kousick Biswas, J. Michael Gaziano, Rosemary F Kelly, Elaine E. Tseng, Jerene Bitondo, Jacquelyn A. Quin, G. Hossein Almassi, Miguel Haime, Brack Hattler, Ellen DeMatt, Alexandra Scrymgeour, Grant D. Huang

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Abstract

BACKGROUND The saphenous-vein graft is the most common conduit for coronary-artery bypass grafting (CABG). The influence of the vein-graft harvesting technique on long-term clinical outcomes has not been well characterized. METHODS We randomly assigned patients undergoing CABG at 16 Veterans Affairs cardiac surgery centers to either open or endoscopic vein-graft harvesting. The primary outcome was a composite of major adverse cardiac events, including death from any cause, nonfatal myocardial infarction, and repeat revascularization. Leg-wound complications were also evaluated. RESULTS A total of 1150 patients underwent randomization. Over a median follow-up of 2.78 years, the primary outcome occurred in 89 patients (15.5%) in the open-harvest group and 80 patients (13.9%) in the endoscopic-harvest group (hazard ratio, 1.12; 95% confidence interval [CI], 0.83 to 1.51; P=0.47). A total of 46 patients (8.0%) in the open-harvest group and 37 patients (6.4%) in the endoscopic-harvest group died (hazard ratio, 1.25; 95% CI, 0.81 to 1.92); myocardial infarc-tions occurred in 34 patients (5.9%) in the open-harvest group and 27 patients (4.7%) in the endoscopic-harvest group (hazard ratio, 1.27; 95% CI, 0.77 to 2.11), and revascularization occurred in 35 patients (6.1%) in the open-harvest group and 31 patients (5.4%) in the endoscopic-harvest group (hazard ratio, 1.14; 95% CI, 0.70 to 1.85). Leg-wound infections occurred in 18 patients (3.1%) in the open-harvest group and in 8 patients (1.4%) in the endoscopic-harvest group (relative risk, 2.26; 95% CI, 0.99 to 5.15). CONCLUSIONS Among patients undergoing CABG, we did not find a significant difference between open vein-graft harvesting and endoscopic vein-graft harvesting in the risk of major adverse cardiac events. (Funded by the Cooperative Studies Program, Office of Research and Development, Department of Veterans Affairs; REGROUP ClinicalTrials.gov number, NCT01850082).

Original languageEnglish (US)
Pages (from-to)132-141
Number of pages10
JournalNew England Journal of Medicine
Volume380
Issue number2
DOIs
StatePublished - Jan 10 2019

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Coronary Artery Bypass
Veins
Transplants
Confidence Intervals
Veterans
Leg
Saphenous Vein
Wound Infection
Random Allocation
Thoracic Surgery
Cause of Death
Myocardial Infarction

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Zenati, M. A., Bhatt, D. L., Bakaeen, F. G., Stock, E. M., Biswas, K., Michael Gaziano, J., ... Huang, G. D. (2019). Randomized trial of endoscopic or open vein-graft harvesting for coronary-artery bypass. New England Journal of Medicine, 380(2), 132-141. https://doi.org/10.1056/NEJMoa1812390

Randomized trial of endoscopic or open vein-graft harvesting for coronary-artery bypass. / Zenati, Marco A.; Bhatt, Deepak L.; Bakaeen, Faisal G.; Stock, Eileen M.; Biswas, Kousick; Michael Gaziano, J.; Kelly, Rosemary F; Tseng, Elaine E.; Bitondo, Jerene; Quin, Jacquelyn A.; Hossein Almassi, G.; Haime, Miguel; Hattler, Brack; DeMatt, Ellen; Scrymgeour, Alexandra; Huang, Grant D.

In: New England Journal of Medicine, Vol. 380, No. 2, 10.01.2019, p. 132-141.

Research output: Contribution to journalArticle

Zenati, MA, Bhatt, DL, Bakaeen, FG, Stock, EM, Biswas, K, Michael Gaziano, J, Kelly, RF, Tseng, EE, Bitondo, J, Quin, JA, Hossein Almassi, G, Haime, M, Hattler, B, DeMatt, E, Scrymgeour, A & Huang, GD 2019, 'Randomized trial of endoscopic or open vein-graft harvesting for coronary-artery bypass', New England Journal of Medicine, vol. 380, no. 2, pp. 132-141. https://doi.org/10.1056/NEJMoa1812390
Zenati MA, Bhatt DL, Bakaeen FG, Stock EM, Biswas K, Michael Gaziano J et al. Randomized trial of endoscopic or open vein-graft harvesting for coronary-artery bypass. New England Journal of Medicine. 2019 Jan 10;380(2):132-141. https://doi.org/10.1056/NEJMoa1812390
Zenati, Marco A. ; Bhatt, Deepak L. ; Bakaeen, Faisal G. ; Stock, Eileen M. ; Biswas, Kousick ; Michael Gaziano, J. ; Kelly, Rosemary F ; Tseng, Elaine E. ; Bitondo, Jerene ; Quin, Jacquelyn A. ; Hossein Almassi, G. ; Haime, Miguel ; Hattler, Brack ; DeMatt, Ellen ; Scrymgeour, Alexandra ; Huang, Grant D. / Randomized trial of endoscopic or open vein-graft harvesting for coronary-artery bypass. In: New England Journal of Medicine. 2019 ; Vol. 380, No. 2. pp. 132-141.
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abstract = "BACKGROUND The saphenous-vein graft is the most common conduit for coronary-artery bypass grafting (CABG). The influence of the vein-graft harvesting technique on long-term clinical outcomes has not been well characterized. METHODS We randomly assigned patients undergoing CABG at 16 Veterans Affairs cardiac surgery centers to either open or endoscopic vein-graft harvesting. The primary outcome was a composite of major adverse cardiac events, including death from any cause, nonfatal myocardial infarction, and repeat revascularization. Leg-wound complications were also evaluated. RESULTS A total of 1150 patients underwent randomization. Over a median follow-up of 2.78 years, the primary outcome occurred in 89 patients (15.5{\%}) in the open-harvest group and 80 patients (13.9{\%}) in the endoscopic-harvest group (hazard ratio, 1.12; 95{\%} confidence interval [CI], 0.83 to 1.51; P=0.47). A total of 46 patients (8.0{\%}) in the open-harvest group and 37 patients (6.4{\%}) in the endoscopic-harvest group died (hazard ratio, 1.25; 95{\%} CI, 0.81 to 1.92); myocardial infarc-tions occurred in 34 patients (5.9{\%}) in the open-harvest group and 27 patients (4.7{\%}) in the endoscopic-harvest group (hazard ratio, 1.27; 95{\%} CI, 0.77 to 2.11), and revascularization occurred in 35 patients (6.1{\%}) in the open-harvest group and 31 patients (5.4{\%}) in the endoscopic-harvest group (hazard ratio, 1.14; 95{\%} CI, 0.70 to 1.85). Leg-wound infections occurred in 18 patients (3.1{\%}) in the open-harvest group and in 8 patients (1.4{\%}) in the endoscopic-harvest group (relative risk, 2.26; 95{\%} CI, 0.99 to 5.15). CONCLUSIONS Among patients undergoing CABG, we did not find a significant difference between open vein-graft harvesting and endoscopic vein-graft harvesting in the risk of major adverse cardiac events. (Funded by the Cooperative Studies Program, Office of Research and Development, Department of Veterans Affairs; REGROUP ClinicalTrials.gov number, NCT01850082).",
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T1 - Randomized trial of endoscopic or open vein-graft harvesting for coronary-artery bypass

AU - Zenati, Marco A.

AU - Bhatt, Deepak L.

AU - Bakaeen, Faisal G.

AU - Stock, Eileen M.

AU - Biswas, Kousick

AU - Michael Gaziano, J.

AU - Kelly, Rosemary F

AU - Tseng, Elaine E.

AU - Bitondo, Jerene

AU - Quin, Jacquelyn A.

AU - Hossein Almassi, G.

AU - Haime, Miguel

AU - Hattler, Brack

AU - DeMatt, Ellen

AU - Scrymgeour, Alexandra

AU - Huang, Grant D.

PY - 2019/1/10

Y1 - 2019/1/10

N2 - BACKGROUND The saphenous-vein graft is the most common conduit for coronary-artery bypass grafting (CABG). The influence of the vein-graft harvesting technique on long-term clinical outcomes has not been well characterized. METHODS We randomly assigned patients undergoing CABG at 16 Veterans Affairs cardiac surgery centers to either open or endoscopic vein-graft harvesting. The primary outcome was a composite of major adverse cardiac events, including death from any cause, nonfatal myocardial infarction, and repeat revascularization. Leg-wound complications were also evaluated. RESULTS A total of 1150 patients underwent randomization. Over a median follow-up of 2.78 years, the primary outcome occurred in 89 patients (15.5%) in the open-harvest group and 80 patients (13.9%) in the endoscopic-harvest group (hazard ratio, 1.12; 95% confidence interval [CI], 0.83 to 1.51; P=0.47). A total of 46 patients (8.0%) in the open-harvest group and 37 patients (6.4%) in the endoscopic-harvest group died (hazard ratio, 1.25; 95% CI, 0.81 to 1.92); myocardial infarc-tions occurred in 34 patients (5.9%) in the open-harvest group and 27 patients (4.7%) in the endoscopic-harvest group (hazard ratio, 1.27; 95% CI, 0.77 to 2.11), and revascularization occurred in 35 patients (6.1%) in the open-harvest group and 31 patients (5.4%) in the endoscopic-harvest group (hazard ratio, 1.14; 95% CI, 0.70 to 1.85). Leg-wound infections occurred in 18 patients (3.1%) in the open-harvest group and in 8 patients (1.4%) in the endoscopic-harvest group (relative risk, 2.26; 95% CI, 0.99 to 5.15). CONCLUSIONS Among patients undergoing CABG, we did not find a significant difference between open vein-graft harvesting and endoscopic vein-graft harvesting in the risk of major adverse cardiac events. (Funded by the Cooperative Studies Program, Office of Research and Development, Department of Veterans Affairs; REGROUP ClinicalTrials.gov number, NCT01850082).

AB - BACKGROUND The saphenous-vein graft is the most common conduit for coronary-artery bypass grafting (CABG). The influence of the vein-graft harvesting technique on long-term clinical outcomes has not been well characterized. METHODS We randomly assigned patients undergoing CABG at 16 Veterans Affairs cardiac surgery centers to either open or endoscopic vein-graft harvesting. The primary outcome was a composite of major adverse cardiac events, including death from any cause, nonfatal myocardial infarction, and repeat revascularization. Leg-wound complications were also evaluated. RESULTS A total of 1150 patients underwent randomization. Over a median follow-up of 2.78 years, the primary outcome occurred in 89 patients (15.5%) in the open-harvest group and 80 patients (13.9%) in the endoscopic-harvest group (hazard ratio, 1.12; 95% confidence interval [CI], 0.83 to 1.51; P=0.47). A total of 46 patients (8.0%) in the open-harvest group and 37 patients (6.4%) in the endoscopic-harvest group died (hazard ratio, 1.25; 95% CI, 0.81 to 1.92); myocardial infarc-tions occurred in 34 patients (5.9%) in the open-harvest group and 27 patients (4.7%) in the endoscopic-harvest group (hazard ratio, 1.27; 95% CI, 0.77 to 2.11), and revascularization occurred in 35 patients (6.1%) in the open-harvest group and 31 patients (5.4%) in the endoscopic-harvest group (hazard ratio, 1.14; 95% CI, 0.70 to 1.85). Leg-wound infections occurred in 18 patients (3.1%) in the open-harvest group and in 8 patients (1.4%) in the endoscopic-harvest group (relative risk, 2.26; 95% CI, 0.99 to 5.15). CONCLUSIONS Among patients undergoing CABG, we did not find a significant difference between open vein-graft harvesting and endoscopic vein-graft harvesting in the risk of major adverse cardiac events. (Funded by the Cooperative Studies Program, Office of Research and Development, Department of Veterans Affairs; REGROUP ClinicalTrials.gov number, NCT01850082).

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