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Endoscopic vein graft harvesting detrimental in CABG
Traditional saphenous vein harvesting, so called “open harvesting”, occurs under direct inspection with the aid of several linear incisions along the course of the vein. However, this technique is associated with some discomfort and also oedema, haematoma, delayed healing, cellulitis and wound dehiscence. Endoscopic vein graft harvesting was developed in an attempt to deal with some of these problems. However, to date there has been little information about the effect of this technique on long-term graft patency or on clinical outcomes.
This study was conducted through the PREVENT-IV trial (Project of Ex-vivo Vein Graft Engineering Versus Transfection). This was a phase 3 multicentre randomised, double-blind, placebo-controlled trial of ex vivo treatment of vein grafts with the E2F transcription factor decoy edifoligide, and the main results have previously been reported. The trial was conducted at 107 sites in the USA and enrolled over 3000 patients. Patients who were aged >18 years and undergoing a first isolated coronary artery bypass grafting (CABG) with at least two planned vein graft conduits were eligible. The first 2400 patients enrolled were in an angiographic cohort and were scheduled for follow-up angiographic assessment at 12–18 months.
Vein graft failure was defined as stenosis of at least 75% of the graft diameter. All angiograms were analysed in a core laboratory by people blinded to the harvesting technique used. Clinical events including death, myocardial infarction (MI) and revascularisation were assessed annually via telephone and mail contact with the patients. Both percutaneous coronary intervention and repeat CABG were adjudicated as revascularisation events.
A total of 1753 patients underwent endoscopic harvesting and 1247 underwent open harvesting; baseline characteristics of the two groups were similar. Patients who underwent endoscopic harvesting had higher rates of vein graft failure at 12–18 months than those who underwent open harvesting (46.7% vs 38.0%, p<0.001). At …