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REGROUP: Event rate similar in open vs. endoscopic vein grafting for CABG
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CHICAGO — There were no significant differences between open vein graft harvesting and endoscopic vein graft harvesting in risk for major adverse cardiac events in veterans who underwent CABG, according to data presented at the American Heart Association Scientific Sessions.
Marco A. Zenati, MD, professor of surgery at Harvard Medical School, chief of cardiothoracic surgery at the Veterans Affairs Boston and associate surgeon at Brigham and Women's Hospital, and colleagues analyzed data from 1,150 patients (mean age, 66 years; 100% men) who had planned elective or urgent CABG with the median sternotomy approach and at least one saphenous vein graft that was planned to be used as a conduit.
The study was simultaneously published in The New England Journal of Medicine.
Patients were assigned either endoscopic (n = 576) or open vein graft harvesting (n = 574).
Follow-up was conducted for at least 1 year by telephone calls, in-clinic visits or medical chart review. Patients underwent assessments at baseline, during surgery, after surgery, either at discharge or 30 days after surgery, 6 weeks and every 3 months thereafter for 2 additional years.
The primary outcome was the first occurrence of a major adverse cardiac event, defined as a composite of nonfatal MI, all-cause death or repeat revascularization. The secondary outcome was defined as major adverse cardiac events at 1 year after surgery. Other outcomes of interest included severity of incisional leg pain at discharge at 6 weeks after surgery, leg wounds and leg wound infections.
During a median follow-up of 2.78 years, there was no difference regarding the primary outcome in patients assigned open vein graft harvesting or endoscopic harvesting (15.5% vs. 13.9%, respectively; HR = 1.12; 95% CI, 0.83-1.51). Death occurred in 8% of patients in the open harvest group vs. 6.4% of those in the endoscopic harvest group (HR = 1.25; 95% CI, 0.81-1.92). Patients assigned endoscopic harvest had fewer recurrent events compared with those assigned open harvest (HR = 1.29; 95% CI, 1-1.68).
MI occurred in 5.9% of patients assigned open vein graft harvesting and 4.7% of those assigned endoscopic harvesting (HR = 1.27; 95% CI, 0.77-2.11). Repeat revascularization was performed in 6.1% of patients in the open harvest group and 5.4% of those in the endoscopic harvest group (HR = 1.14; 95% CI, 0.7-1.85).
Fewer patients assigned endoscopic harvesting had leg wound infections compared with those assigned open vein harvesting (1.4% vs. 3.1%; absolute difference = 1.7 percentage points; RR = 2.26; 95% CI, 0.99-5.15).
“Endoscopic harvest performed by an expert may be considered the preferred vein harvesting modality,” Zenati said during a press conference.
“Is this the last trial? I think it is,” Marc Ruel, MD, MPH, FRCSC, FCCS, FAHA, division head of cardiac surgery and the endowed chair of cardiac surgery research at University of Ottawa Heart Institute, said during the discussant portion of the press conference. “This question is fully answered, but is endoscopic vein harvest central to a better CABG product? It probably is, but I think a better CABG product has many other ramifications than purely endoscopic vein harvesting, including multiple arterial grafts, better secondary prevention and perhaps no-touch pedicled vein harvesting.” – by Darlene Dobkowski
References:
Zenati MA, et al. LBS.06 – Late Breaking Science in Coronary Revascularization. Presented at: American Heart Association Scientific Sessions; Nov. 10-12, 2018; Chicago.
Zenati MA, et al. N Engl J Med. 2018;doi:10.1056/NEJMoa1812390.
Disclosures: Zenati reports no relevant financial disclosures. Ruel reports he received honoraria from Abbott, a research grant from Medtronic for the MIST trial and other research support from Cryolife and Edwards Lifesciences. Please see the study for all other authors’ relevant financial disclosures.