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Endoscopic Harvesting Device Type and Outcomes in Patients Undergoing Coronary Artery Bypass Surgery

van Diepen, Sean MD, MSc*; Brennan, J. Matthew MD, MPH; Hafley, Gail E. MS; Reyes, Eric M. PhD; Allen, Keith B. MD; Ferguson, T. Bruce MD§; Peterson, Eric D. MD, MPH; Williams, Judson B. MD, MHS; Gibson, C. Michael MD; Mack, Michael J. MD; Kouchoukos, Nicholas T. MD**; Alexander, John H. MD, MHS; Lopes, Renato D. MD, PhD

doi: 10.1097/SLA.0000000000000377
Original Articles

Objective: To evaluate angiographic and clinical outcomes associated with open and closed dissection tunnel endoscopic vein harvesting (EVH) devices.

Background: A previous PREVENT-IV (PRoject of Ex-vivo Vein graft ENgineering via Transfection IV) analysis reported that EVH for coronary artery bypass graft surgery was associated with worse outcomes than with traditional vein harvesting; however, outcomes by EVH device type were not available.

Methods: Using data from the PREVENT-IV trial, we compared 1549 patients from 75 surgical sites who underwent EVH with open (n = 390) or closed (n = 1159) harvest tunnel devices. Outcomes included the incidence of vein graft failure at 12 to 18 months and a composite of death, myocardial infarction, and revascularization through 5 years.

Results: Among patients undergoing open and closed tunnel EVH, no difference in the per-patient incidence of vein graft failure (43.8% vs 47.1%; adjusted odds ratio, 0.91; 95% confidence interval, 0.53–1.55; P = 0.724) or per-graft incidence of vein graft failure (25.5% vs 25.9%; adjusted odds ratio, 0.96; 95% confidence interval, 0.59–1.55; P = 0.847) was observed. At 5 years, no difference was observed in the primary composite clinical outcome between patients who underwent open and closed system EVH (21.5% vs 23.9%; adjusted hazard ratio, 0.85; 95% confidence interval, 0.66–1.10; P = 0.221).

Conclusions: No differences in angiographic or clinical outcomes were observed among patients who underwent open versus closed tunnel endoscopic harvesting for coronary bypass surgery. These findings suggest that the risks associated with EVH that were reported in a previous PREVENT-IV analysis are not related to a specific EVH device.

Studies comparing open and endoscopic vein harvesting have reported different associations with vein graft failure and mortality; however, these analyses lacked device-specific information. This analysis found no difference in vein graft failure or the composite of death, myocardial infarction, or revascularization between open and closed tunnel endoscopic vein harvesting systems.

*Division of Critical Care and Cardiology, University of Alberta, Edmonton, Alberta, Canada

Duke Clinical Research Institute, Duke University Medical Center, Durham, NC

Mid America Heart Institute, St. Luke's Hospital, Kansas City, MO

§East Carolina University, Greenville, NC

PERFUSE Angiographic Laboratory, Boston, MA

Baylor Healthcare System, Dallas, TX

**Missouri Baptist Medical Center, St. Louis, MO.

Reprints: Renato D. Lopes, MD, PhD, Duke Clinical Research Institute, Duke University Medical Center, Box 3850, 2400 Pratt St, Room 0311, Terrace Level, Durham, NC 27705. E-mail: renato.lopes@duke.edu.

Disclosure: PREVENT-IV trial was sponsored by Corgentech. This article was funded by the Duke Clinical Research Institute. The authors (S.v.D., G.E.H., E.R.R., K.B.A., J.B.W., T.B.F., C.M.G., and N.T.K.) declare no conflicts of interest. Disclosures for J.M.B., E.D.P., J.H.A., and R.D.L. are publicly available at www.dcri.org/about-us/conflict-of-interest. M.J.M. has received consulting fees from MAQUET.

© 2014 by Lippincott Williams & Wilkins.