Introduction:
Endoscopic saphenous vein harvesting has developed into a standard of care at many cardiothoracic surgical centers. The association between this technique and long-term morbidity and mortality has recently been called into question. We describe the association between use of open versus endoscopic vein harvesting and the risk of mortality and repeat revascularization within northern New England during a time period (2001-2004) in which both techniques were being performed.
Methods:
Prospective cohort study. From 2001-2004, 52.5% (4,485 of 8,542) of patients undergoing isolated coronary artery bypass grafting surgery had their saphenous vein harvested endoscopically. Surgical discretion dictated the vein harvest approach.
Results:
Use of endoscopic vein harvesting increased from 34% (781 of 2,291) in 2001 to 75% (1,341 of 1,792) in 2004. Patients undergoing endoscopic vein harvesting had greater disease burden. Endoscopic vein harvesting was associated with a significant reduction in long-term mortality [adjHR: 0.79, (CI 95% 0.68, 0.91)] and risk of repeat revascularization or mortality [adjHR: 0.87, (CI 95% 0.78, 0.98), Figure]. Endoscopic vein harvesting was associated with a non-significant increased risk of repeat revascularization [adjHR: 1.08, (CI 95% 0.89, 1.31)]. Similar results were obtained in a propensity-matched analysis.
Conclusion:
The use of endoscopic vein harvesting was associated with a reduced risk of mortality as well as a composite endpoint of mortality or repeat revascularization four years after the index admission. This practice insignificantly increased the risk of repeat revascularization.
Response to Letter Regarding Article, “Long-Term Outcomes of Endoscopic Vein Harvesting After Coronary Artery Bypass Grafting”
