Zenati MA, et al. - In this randomized, intention-to-treat, multicenter trial, researchers evaluated the clinical outcomes of open or endoscopic vein-graft harvesting in coronary-artery bypass grafting (CABG) surgery. No significant difference was found between open vein-graft harvesting and endoscopic vein-graft harvesting in the risk of major adverse cardiac events among patients undergoing CABG. In the endoscopic-harvest group, the rate of wound complications was lower than in the open-harvest group.

Methods

• For this investigation, patients undergoing CABG at 16 Veterans Affairs cardiac surgery centers to either open or endoscopic vein-graft harvesting were randomly assigned.
• A composite of major adverse cardiac events, including death from any cause, nonfatal myocardial infarction, and repeat revascularization was the primary outcome.
• In addition, leg-wound complications were assessed.

Results

• A total of 1150 patients were randomized.
• The primary outcome in 89 patients (15.5%) in the open-harvest group and 80 patients (13.9%) in the endoscopic-harvest group (hazard ratio, 1.12; 95% confidence interval [CI], 0.83 to 1.51; P=0.47) was observed over a median follow-up of 2.78 years.
• A total of 46 patients (8.0%) in the open-harvest group and 37 patients (6.4%) in the endoscopic-harvest group died (hazard ratio, 1.25; 95% CI, 0.81 to 1.92); myocardial infarctions occurred in 34 patients (5.9%) in the open-harvest group and 27 patients (4.7%) in the endoscopic-harvest group (hazard ratio, 1.27; 95% CI, 0.77 to 2.11), and revascularization occurred in 35 patients (6.1%) in the open-harvest group and 31 patients (5.4%) in the endoscopic-harvest group (hazard ratio, 1.14; 95% CI, 0.70 to 1.85).
• Leg-wound infections occurred in 18 patients (3.1%) in the open-harvest group and in 8 patients (1.4%) in the endoscopic-harvest group (relative risk, 2.26; 95% CI, 0.99 to 5.15).