Impact of endoscopic versus open saphenous vein harvest technique on late coronary artery bypass grafting patient outcomes in the ROOBY (Randomized On/Off Bypass) Trial

Zenati, Marco A.; Shroyer, A. Laurie; Collins, Joseph F.; Hattler, Brack G.; Ota, Takeyoshi; Almassi, G. Hossein; Amidi, Morteza; Novitzky, D.; Grover, Frederick L.; Sonel, Ali F.

doi:10.1016/j.jtcvs.2010.10.004

Cited by 134 publications

(84 citation statements)

References 25 publications

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“…As described previously, a subgroup analysis of the ROOBY trial suggested that endoscopic vein harvesting was associated with worse outcomes (21). A secondary analysis of patients from the PREVENT IV trial at 3 years of follow-up also showed worse outcomes for patients undergoing endoscopic harvesting, but this finding has not been confirmed in other observational studies (29,31).…”

Section: Is Endoscopic Vein Harvesting Safe?mentioning

confidence: 82%

Almanac 2012 adult cardiac surgery

Bridgewater¹

2013

Anadolu Kardiyol Derg

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This review covers the important publications in adult cardiac surgery in the last few years, including the current evidence base for surgical revascularisation and the use of off-pump surgery, bilateral internal mammary arteries and endoscopic vein harvesting. The changes in conventional aortic valve surgery are described alongside the outcomes of clinical trials and registries for transcatheter aortic valve implantation, and the introduction of less invasive and novel approaches of conventional aortic valve replacement surgery. Surgery for mitral valve disease is also considered, with particular reference to surgery for asymptomatic degenerative mitral regurgitation. (Anadolu Kardiyol Derg 2013; 13: 414-21) ALMANAC series ALMANAC serileri 414

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Section: Is Endoscopic Vein Harvesting Safe?mentioning

confidence: 82%

Almanac 2012 adult cardiac surgery

Bridgewater¹

2013

Anadolu Kardiyol Derg

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“…One major limitation of the current literature is that there is very little conclusive data regarding long-term patency rates of endoscopically harvested veins. There are some concerns that endoscopic vein harvest could be connected with a detrimental effect on vein endothelium which could promote a thrombogenic environment leading to a decrease in graft patency (Rousou et al 15 and Zenati et al 16 ). In our study, we found a statistically significant difference between the EVH and OVH groups in terms of percentage of endothelial damage which was statistically significantly higher in the EVH group.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic vs open saphenous vein harvest for coronary artery bypass grafting: A leg-related morbidity and histological comparison

Brát¹,

Horáček²,

Sieja³

2013

BIOMED PAP

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Aims. The aim of this study was to compare coronary artery bypass grafting (CABG) using either endoscopic (EVH) or open harvest (OVH). Leg-related morbidity and histological comparison of the veins were the outcome measures. Methods. One hundred consecutive patients scheduled for isolated CABG were randomly divided into two goups: an EVH and OVH group. Perioperative data were recorded. Patients were examined 7 days and 1 month postoperatively for leg-related morbidity. Samples for histological examination were taken from each harvested vein during the surgery. Results. Postoperative pain was statistically significantly lower in the EVH group 7 days postoperatively but the incidence of haematoma was non statistically higher in the EVH group while swelling was higher in the OVH group. Almost 40% of all histological samples were described as showing endothelial damage. There was significantly more endothelial damage in the EVH than the OVH group. Conclusions. We confirmed the advantage of EVH in terms of leg-related morbidity as well as cosmetic effect. This method however, was associated with more acute endothelial damage of the graft. These results support concerns that endoscopic vein harvest may be connected with detrimental effects on vein endothelium which could promote a thrombogenic environment leading to a decrease in graft patency. This could be extremely important. The results suggest that further investigation of the long-term patency of vein grafts harvested endoscopically is required.

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“…For instance, in the PREVENT IV trial, 8 1829 patients had follow-up angiography 12-18 months after CABG that showed per-patient vein graft failure rate was 445% (each patient had at least two vein grafts), while per-graft vein graft occlusion rate was 426%. In the latest ROOBY trial, 9 the incidence of vein graft occlusion during the first postoperative year in 894 patients was 414% (following conventional harvesting) or up to 25% (following endoscopic harvesting). Such failure rates are similar to those reported in 1996 by Fitzgibbon et al 3 Knowledge about the pathophysiology of vein graft failure has significantly enhanced recently (this is discussed in detail below).…”

Section: Clinical Use Of Autologous Saphenous Veinmentioning

confidence: 99%

Vein graft failure: current clinical practice and potential for gene therapeutics

et al. 2012

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Autologous saphenous vein is commonly used as a conduit to bypass atherosclerotic lesions in coronary and femoral arteries. Despite the wide use of arterial conduits, which are less susceptible to complications and failure, as alternative conduits, the saphenous vein will continue to be used in coronary artery bypass grafting until acceptable alternative approaches are evaluated. Hence, preservation of vein graft patency is essential for the long-term success. Gene therapy is attractive in this setting as an ex-vivo technology to genetically manipulate the conduit before grafting. The use of safe and efficient vectors for delivery is a necessity as well as a strategy to improve patency in the long term. Here, we review the current clinical practice, the pathogenesis of bypass graft failure and adenovirus-mediated gene therapy strategies designed to improve late vein graft failure by modulation of smooth muscle cells in the vein wall.

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Impact of endoscopic versus open saphenous vein harvest technique on late coronary artery bypass grafting patient outcomes in the ROOBY (Randomized On/Off Bypass) Trial

Abstract: In the ROOBY Trial, endoscopic vein harvest was associated with lower 1-year saphenous vein graft patency and higher 1-year revascularization rates, independent of the use of off-pump or on-pump cardiac surgical approach.

Cited by 134 publications

References 25 publications

Almanac 2012 adult cardiac surgery

Almanac 2012 adult cardiac surgery

Endoscopic vs open saphenous vein harvest for coronary artery bypass grafting: A leg-related morbidity and histological comparison

Vein graft failure: current clinical practice and potential for gene therapeutics

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