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

Research output: Contribution to journalArticlepeer-review

51 Scopus citations

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

Bibliographical note

Funding Information:
Supported by the Cooperative Studies Program, Office of Research and Development, Department of Veterans Affairs (CSP 588).

Funding Information:
We conducted a randomized, intention-to-treat, multicenter trial funded by the Cooperative Studies Program of the Department of Veterans Affairs. The rationale and design of the trial have been published previously.13 Cardiac surgery programs at Veterans Affairs medical centers with expertise in performing endoscopic vein-graft harvesting were eligible to participate. An executive committee was responsible for trial oversight. The trial was approved by the institutional review board at each participating center. Patients gave written informed consent before participation. The authors vouch for the accuracy and completeness of the data and the analyses and for the fidelity of the trial to the protocol, which is available with the full text of this article at NEJM.org.

Publisher Copyright:
Copyright © 2018 Massachusetts Medical Society.

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