Long-term outcomes of endoscopic vein harvesting after coronary artery bypass grafting.
نویسندگان
چکیده
BACKGROUND Use of endoscopic saphenous vein harvesting has developed into a routine surgical approach at many cardiothoracic surgical centers. The association between this technique and long-term morbidity and mortality has recently been called into question. The present report describes the use of open versus endoscopic vein harvesting and risk of mortality and repeat revascularization in northern New England during a time period (2001 to 2004) in which both techniques were being performed. METHODS AND RESULTS From 2001 to 2004, 8542 patients underwent isolated coronary artery bypass grafting procedures, 52.5% with endoscopic vein harvesting. Surgical discretion dictated the vein harvest approach. The main outcomes were death and repeat revascularization (percutaneous coronary intervention or coronary artery bypass grafting) within 4 years of the index admission. The use of endoscopic vein harvesting increased from 34% in 2001 to 75% in 2004. In general, patients undergoing endoscopic vein harvesting had greater disease burden. Endoscopic vein harvesting was associated with an increased adjusted risk of bleeding requiring a return to the operating room (2.4 versus 1.7; P=0.03) but a decreased risk of leg wound infections (0.2 versus 1.1; P<0.001). Use of endoscopic vein harvesting was associated with a significant reduction in long-term mortality (adjusted hazard ratio, 0.74; 95% confidence interval, 0.60 to 0.92) but a nonsignificant increased risk of repeat revascularization (adjusted hazard ratio, 1.29; 95% confidence interval, 0.96 to 1.74). Similar results were obtained in propensity-stratified analysis. CONCLUSIONS During 2001 to 2004 in northern New England, the use of endoscopic vein harvesting was not associated with harm. There was a nonsignificant increase in repeat revascularization, and survival was not decreased.
منابع مشابه
Letter by Deutsch et al regarding article, "Long-term outcomes of endoscopic vein harvesting after coronary artery bypass grafting".
متن کامل
Endoscopic Saphenous harvesting with an Open CO2 System (ESOS) trial for coronary artery bypass grafting surgery: study protocol for a randomized controlled trial
BACKGROUND In coronary artery bypass grafting surgery, arterial conduits are preferred because of more favourable long-term patency and outcome. Anyway the greater saphenous vein continues to be the most commonly used bypass conduit. Minimally invasive endoscopic saphenous vein harvesting is increasingly being investigated in order to reduce the morbidity associated with conventional open vein ...
متن کاملEndoscopic versus open vein-graft harvesting in coronary-artery bypass surgery.
BACKGROUND Vein-graft harvesting with the use of endoscopy (endoscopic harvesting) is a technique that is widely used to reduce postoperative wound complications after coronary-artery bypass grafting (CABG), but the long-term effects on the rate of vein-graft failure and on clinical outcomes are unknown. METHODS We studied the outcomes in patients who underwent endoscopic harvesting (1753 pat...
متن کاملSimultaneous endoscopic radial artery and great saphenous vein harvesting for redo coronary artery bypass grafting. A report of two cases.
AIM An ageing population and increase in patient co-morbidities are forcing cardiac surgeons to meticulously consider the benefits and risks of respective conduits and their harvesting techniques. CASE REPORTS Two cases of simultaneous endoscopic radial artery and great saphenous vein harvesting, for redo coronary artery bypass grafting, are presented. A shortage of venous conduits after prev...
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Background The greater saphenous vein is commonly used in coronary revascularization. Beside classical methods of vein harvesting, endoscopic technique is applied. The introduction of endoscopic vein harvesting remains still controversial and therefore needs some more data resulting from application of this method. This study was performed to investigate the influence of endoscopic and open sap...
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ورودعنوان ژورنال:
- Circulation
دوره 123 2 شماره
صفحات -
تاریخ انتشار 2011