Randomized Trial of Endoscopic or Open Vein-Graft Harvesting for Coronary-Artery Bypass

作者：Marco A. Zenati, Deepak L. Bhatt, Faisal G. Bakaeen, Eileen M. Stock, Kousick Biswas, J. Michael Gaziano, Rosemary F. Kelly, Elaine Tseng, Jerene Bitondo, Jacquelyn A. Quin, G. Hossein Almassi, Miguel Haime, Brack Hattler, Ellen DeMatt, Alexandra Scrymgeour, Grant D. Huang · 发表于：New England Journal of Medicine · 年份：2018 · DOI：10.1056/nejmoa1812390 · 被引用次数：138 · 研究领域：Cardiac and Coronary Surgery Techniques、Mechanical Circulatory Support Devices、Coronary Interventions and Diagnostics

BACKGROUND: The saphenous-vein graft is the most common conduit for coronary-artery bypass grafting (CABG). The influence of the vein-graft harvesting technique on long-term clinical outcomes has not been well characterized. METHODS: We randomly assigned patients undergoing CABG at 16 Veterans Affairs cardiac surgery centers to either open or endoscopic vein-graft harvesting. The primary outcome was a composite of major adverse cardiac events, including death from any cause, nonfatal myocardial infarction, and repeat revascularization. Leg-wound complications were also evaluated. RESULTS: A total of 1150 patients underwent randomization. Over a median follow-up of 2.78 years, the primary outcome occurred in 89 patients (15.5%) in the open-harvest group and 80 patients (13.9%) in the endoscopic-harvest group (hazard ratio, 1.12; 95% confidence interval [CI], 0.83 to 1.51; P=0.47). A total of 46 patients (8.0%) in the open-harvest group and 37 patients (6.4%) in the endoscopic-harvest group died (hazard ratio, 1.25; 95% CI, 0.81 to 1.92); myocardial infarctions occurred in 34 patients (5.9%) in the open-harvest group and 27 patients (4.7%) in the endoscopic-harvest group (hazard ratio, 1.27; 95% CI, 0.77 to 2.11), and revascularization occurred in 35 patients (6.1%) in the open-harvest group and 31 patients (5.4%) in the endoscopic-harvest group (hazard ratio, 1.14; 95% CI, 0.70 to 1.85). Leg-wound infections occurred in 18 patients (3.1%) in the open-harvest group and in 8 pat...