No long-term increased risk of death with endoscopy for bypass surgery

CHICAGO, IL – An analysis of data of patients who underwent coronary artery bypass graft (CABG) surgery found no evidence of a long-term increased risk of death with endoscopic vein-graft harvesting compared to open vein-graft harvesting. The authors also found that the techniques were associated with a significant reduction in wound complications.

The study background states that wide-spread adoption of endoscopic vein-graft harvesting techniques occurred in the mid-1990s, due to perceived advantages such as improved postoperative comfort and incision-site complications. Endoscopic vein-graft harvesting has been used in the majority of over 400,000 CABG surgery procedures performed in the U.S. each year.

In 2009, a study of 3,000 patients questioned the safety of the endoscopic vein-graft harvesting technique, finding that patients who received this procedure had higher 3-year mortality than those receiving open vein-graft harvesting technique.

Judson B. Williams, M.D., M.H.S., of Duke University Medical Center, Durham, N.C., and colleagues conducted a study to assess use of the endoscopic vein-graft harvesting technique in CABG surgery and the risk of death, heart attack, and repeat revascularization.

The study, published in the August 1 issue of JAMA, included 235,394 Medicare patients who had undergone isolated CABG surgery between 2003 and 2008 at 934 surgical centers participating in the Society of Thoracic Surgeons (STS) national database. The STS records were linked to Medicare files to allow longitudinal assessment (median [midpoint] 3-year follow-up) through December 31, 2008.

Endoscopic vein-graft harvesting was found to be used in approximately 70 percent of CABG surgery cases in the STS Adult Cardiac Surgery Database in 2008.

Based on Medicare Part B coding, 52 percent of patients received endoscopic vein-graft harvesting during CABG surgery. The researchers found no significant dAir Jordan