CABG Vein Harvesting Techniques Have Similar MACE Risks
Rates of myocardial infarction and repeat revascularization were similar in the open and endoscopic vein harvest groups.
|The following article is part of conference coverage from the 2018 AHA Scientific Sessions in Chicago, Illinois.The Cardiology Advisor's staff will be reporting breaking news associated with research conducted by leading experts in cardiology. Check back for the latest news from AHA 2018.|
In patients undergoing coronary artery bypass grafting (CABG), no significant difference was found between endoscopic and open vein graft harvesting in terms of major adverse cardiac event (MACE) risk, according to a study presented at the 2018 American Heart Association Scientific Sessions, held November 10-12 in Chicago, Illinois, and simultaneously published in the New England Journal of Medicine.1,2
Researchers from the Randomized Endo-Vein Graft Prospective (REGROUP; ClinicalTrials.gov Identifier: NCT01850082) trial sought to compare the long-term outcomes of open vein harvesting with those of endoscopic vein graft harvesting. MACEs, including death from any cause, nonfatal myocardial infarction, and repeat revascularization, comprised the primary outcome.
Among the 1150 patients who were randomly assigned to either harvesting technique, 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 [HR], 1.12; 95% CI, 0.83-1.51; P =.47) during a median follow-up of 2.78 years.
In the open harvest group, 46 patients (8.0%) died, whereas in the endoscopic harvest group, 37 patients (6.4%) died (HR, 1.25; 95% CI, 0.81-1.92). Rates of myocardial infarction and repeat revascularization were similar in the open and endoscopic harvest groups (5.9% vs 4.7% and 6.1% vs 5.4%, respectively).
In addition, no significant difference was found between open and endoscopic graft harvesting after adjustment for possible influential baseline demographic and clinical characteristics.
However, fewer infections resulting from leg wounds occurred in the endoscopic harvest group than in the open harvest group (8 vs 18 patients; relative risk, 2.26; 95% CI, 0.99-5.15).
The lack of imaging evaluation of graft patency was a potential limitation of the study, as well as the exclusion of off-pump CABG.
“Further studies are needed to establish standards for harvester expertise to ensure the safety of patients and effectiveness of the procedure,” the researchers concluded.
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- Zenati MA, Bhatt DL, Bakaeen FG, et al; for the REGROUP Trial Investigators. Randomized trial of endoscopic or open-vein graft harvesting for coronary-artery bypass [published online November 11, 2018]. N Engl J Med. doi:10.1056/nejmoa1812390
- Zenati MA, Bhatt DL, Bakaeen FG, et al; for the REGROUP Trial Investigators. Endoscopic vein harvest for coronary bypass surgery in a randomized multicenter trial with long-term follow-up. Presented at: American Heart Association 2018 Scientific Sessions; November 10-12, 2018; Chicago, IL. Abstract 19055.