Endoscopic Harvesting Device Type and Outcomes in Patients Undergoing Coronary Artery Bypass Surgery

Abstract

Objective To evaluate angiographic and clinical outcomes associated with open and closed tunnel dissection endoscopic vein harvesting (EVH) devices. Summary Background Data A previous PREVENT-IV analysis reported that EVH for coronary artery bypass graft (CABG) surgery was associated with worse outcomes compared with traditional vein harvesting; however, outcomes by EVH device type were not available. Methods Using data from the PREVENT-IV trial, we compared 1549 patients from 75 surgical sites who underwent EVH with open (n=390) or closed (n=1159) harvest tunnel devices. Outcomes included the incidence of vein graft failure at 12 to 18 months and a composite of death, myocardial infarction, or revascularization through 5 years. Results Among patients undergoing open and closed tunnel EVH, no difference in the per-patient incidence of vein graft failure (43.8% vs. 47.1%; adjusted odds ratio [OR], 0.91; 95% confidence interval [CI], 0.53 to 1.55; p=0.724) or per-graft incidence of vein graft failure (25.5% vs. 25.9%; adjusted OR, 0.96; 95% CI, 0.59 to 1.55; p=0.847) was observed. At 5 years, no difference was observed in the primary composite clinical outcome between open and closed system EVH patients (21.5% vs. 23.9%; adjusted hazard ratio, 0.85; 95% CI, 0.66 to 1.10; p=0.221). Conclusion No differences in angiographic or clinical outcomes were observed among patients who underwent open vs. closed tunnel endoscopic harvesting for coronary bypass surgery. These findings suggest that the risks associated with EVH that were reported in a previous PREVENT-IV analysis are not related to a specific EVH device.

Response to Letters Regarding Article, “Saphenous Vein Graft Failure After Coronary Artery Bypass Surgery: Insights From PREVENT IV”

“…3,4 A recent publication from PREVENTIV suggests that the risk associated with EVH was not explained by the device type. 5 We completely agree that understanding the true impact of EVH on graft patency and clinical outcomes will require an adequately sized randomized trial with appropriate outcomes. To this end, we await the results of the ongoing Randomized Endo-Vein Graft Prospective (REGROUP) trial (clinicaltrials.gov identifier NCT01850082).…”

Decreased patency rates following endoscopic vein harvest in coronary artery bypass surgery

“…information regarding vein graft patency was obtained from CAGs performed in 10 patients prior to follow-up and information on vein graft patency was obtained from the autopsy report in one patient. cluded that this difference was not related to a specific EVH device (10). An increased vein graft failure rate following EVH was shown in a subset of patients undergoing angiographic follow-up at one year from the randomized On/Off Bypass (rOOBY) trial which evaluated differences in clinical outcomes between patients undergoing on-and off-pump CABG (9).…”

“…Similar to the PrEVEnT iV study (10) in which there were no protocol requirements for pre-harvest use of heparin, all grafts in the present study were harvested by the EVH technique without heparinization. Lack of pre-procedural heparinization may, however, result in residual clot strands in the vein grafts and have the potential to decrease vein graft patency rates.…”

“…However, potential negative mid-and longterm effects following EVH have been ventilated, that is, reduced vein graft patency, increased risk rates of repeat revascularization, myocardial infarction (mi), and death (7)(8)(9). in contrast, several reviews and meta-analyses have concluded that EVH can be performed safely without increasing the early and mid-term risks (2, [4][5][6]10,11). This information is primarily based on results from non-randomized studies, and there is a lack of knowledge from ran-domized studies.…”

Endothelial loss during the surgical procedure in saphenous veins harvested by open and endoscopic techniques in coronary artery bypass surgery

“…However, previous investigations of two databases, where many patients were enrolled, revealed that the endoscopic technique was associated with an increased long-term mortality rate and a higher rate of vein graft failure [9,10]. Contrarily, other studies reported that the endoscopic technique was not associated with a higher rate of vein graft failure and an increased mortality rate [11][12][13].…”