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

1. Among patients randomized to an open or endoscopic vein-graft harvest technique for coronary-artery bypass graft (CABG) surgery, there was no difference in major adverse cardiovascular events (MACE) over a median follow-up of 2.78 years.

2. The rate of leg wound complications was lower in the endoscopic-harvest group compared to the open-harvest group.

Evidence Rating Level: 1 (Excellent)      

Study Rundown: Patients undergoing CABG surgery usually have one or more vein grafts placed, which may be harvested using an open or endoscopic technique. Though studies have demonstrated lower rates of harvest-site complications and less pain with the endoscopic technique, vein-graft patency has been consistently lower compared to the open technique. Given that prior studies featured relatively small sample sizes with short follow-up, the Randomized Endovein Graft Prospective (REGROUP) trial was designed to assess clinical outcomes of open or endoscopic vein-graft harvesting in CABG surgery. Investigators found no significant difference in the primary outcome, the first occurrence of a MACE, between open and endoscopic vein-graft harvesting. Furthermore, there was no difference in any of the individual components of the primary outcome and the endoscopic technique was associated with a lower rate of wound complications compared to the open technique. The results suggest endoscopic harvest by an expert surgeon may be the preferred harvesting modality going forward, though further evidence with multiple arterial grafts and the open “no touch” vein-graft harvest technique may impact clinical practice.

This was the largest study to compare the open and endoscopic vein-graft harvest techniques for CABG. A key feature of this study was the high level of expertise required for vein harvesters. Limited information regarding operator expertise has been a criticism of previous studies, but this requirement also limits generalizability of this study’s results. Further limiting generalizability is the exclusion of the open “no touch” technique, which may have superior outcomes to traditional open harvesting.

Click to read the study in NEJM

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