A multicentre review comparing long term outcomes of endoscopic vein harvesting versus open vein harvesting for coronary artery bypass surgery
Open Access
- 8 July 2021
- journal article
- Published by National Institute for Health and Care Research in NIHR Open Research
Abstract
Background: Utilisation of the Endoscopic Vein Harvesting (EVH) technique has been increasing for coronary artery bypass grafting (CABG) for the last two decades. Some surgeons remain concerned about the long-term patency of the long saphenous vein harvested endoscopically compared to traditional Open Vein Harvesting (OVH). The aim of this study was to perform a retrospective analysis of the outcomes between EVH and OVH from three UK centres with 10 years follow-up. Methods: 27,024 patients underwent CABG with long saphenous vein harvested by EVH (n=13,794) or OVH (n=13,230) in three UK centres between 2007 and 2019. Propensity modelling was used to calculate the Inverse Probability of Treatment Weights (IPTW). The primary endpoint was mortality from all causes and secondary endpoints were length of hospital stay, postoperative complications, and incidence of repeat coronary re-vascularisation for symptomatic patients. IPTW was used to balance the two intervention groups for baseline and preoperative co-morbidities. Results: Median follow-up time was 4.54 years for EVH and 6.00 years for OVH. Death from any cause occurred in 13.8% of the EVH group versus 20.8% in the OVH group over the follow-up period. The hazard ratio of death (EVH to OVH) was 0.823 (95% CI: 0.767, 0.884). Length of hospital stay was similar between the groups (p=0.86). Post-operative pulmonary complications were more common in EVH vs OVH (14.7% vs. 12.8%, p<0.001), but repeat coronary re-vascularisation was similar between the groups. Conclusion: This large retrospective multicentre analysis indicates that EVH has a lower risk of mortality compared with OVH during the follow-up period of the study. The observed benefits of EVH may outweigh the risks but should be considered on a case-by-case basis. We hope this review gives confidence to other cardiac centres that offering an EVH approach to conduit harvesting does not affect long term patient outcomes.Keywords
Funding Information
- National Institute of Health Research (PDF-2018-11-ST1-011)
This publication has 28 references indexed in Scilit:
- Benefits of Endoscopic Vein Harvesting in Coronary Artery Bypass GraftingThe Annals of Thoracic Surgery, 2019
- Saphenous vein grafts in contemporary coronary artery bypass graft surgeryNature Reviews Cardiology, 2019
- Development of a risk score for early saphenous vein graft failure: An individual patient data meta-analysisThe Journal of Thoracic and Cardiovascular Surgery, 2019
- Long saphenous vein harvesting techniques and their effect on graft patencyJournal of Cardiac Surgery, 2019
- Randomized Trial of Endoscopic or Open Vein-Graft Harvesting for Coronary-Artery BypassThe New England Journal of Medicine, 2019
- Long-term clinical outcomes after coronary artery bypass grafting with pedicled saphenous vein graftsJournal of Cardiothoracic Surgery, 2018
- Study Comparing Vein Integrity and Clinical Outcomes in Open Vein Harvesting and 2 Types of Endoscopic Vein Harvesting for Coronary Artery Bypass GraftingJournal of the American College of Cardiology, 2017
- A comprehensive review on learning curve associated problems in endoscopic vein harvesting and the requirement for a standardised training programmeJournal of Cardiothoracic Surgery, 2016
- Does the introduction of a comprehensive structured training programme for endoscopic vein harvesting improve conduit quality? A multicentre pilot studyInteractive CardioVascular and Thoracic Surgery, 2014
- Impact of the Learning Curve for Endoscopic Vein Harvest on Conduit Quality and Early Graft PatencyThe Annals of Thoracic Surgery, 2011