Patient Safety and Quality

No greater risk or mortality observed for endoscopic vein harvesting for coronary bypass surgery

During coronary artery bypass surgery, a vein is taken from the leg to replace blocked arteries in the heart. Today, the majority of vein harvesting is done endoscopically rather than using an open surgical procedure. By using this minimally invasive approach, the surgeon can reduce pain and infection. Recently, some experts have questioned whether this approach to leg vein harvesting may expose patients to the risk of vein-graft failure, death, heart attack, and repeated blockages after surgery. A new study that compared the two techniques over a 4-year period found no increase in harm to patients who underwent endoscopic vein harvesting.
Between 2001 and 2004, 8,542 patients underwent coronary artery bypass grafting procedures in northern New England. More than half (52.5 percent) had endoscopic vein harvesting. Over the study period, endoscopic vein harvesting grew in popularity, from 34 percent in 2001 to 75 percent in 2004. Patients receiving endoscopic vein harvesting were more likely to be male, have vascular disease, and have two-vessel disease. They were less likely to have a history of a heart attack or congestive heart failure.
In terms of hospital outcomes, open surgical harvesting was associated with an increase in postoperative leg wound infections. On the other hand, endoscopic harvesting resulted in an increase in patients being returned to the operating room to correct postoperative bleeding.
With respect to long-term outcomes, there was a significant reduction in long-term mortality with endoscopic harvesting. The relatively small increased risk of repeat revascularization over four years with endoscopic harvesting was non-significant. The study was supported in part by the Agency for Healthcare Research and Quality (HS15663).
See "Long-term outcomes of endoscopic vein harvesting after coronary artery bypass grafting," by Lawrence J. Dacey, M.D., John H., Braxton, Jr., M.D., Robert S. Kramer, M.D., and others in the January 18, 2011, Circulation 123(2), pp. 147-153.