Endoscopic vs Open Vein Harvest in Drug-Eluting Stents or Bypass Surgery for Left Main Disease Trial

Craig M. Jarrett, Marc Pelletier, Yasir Abu-Omar, Cristian Baeza, Yakov Elgudin, Alan Markowitz, Pablo Ruda Vega, Ovidiu Dressler, Arie Pieter Kappetein, Patrick W. Serruys, Gregg W. Stone, Joseph F. Sabik*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

1 Citation (Scopus)

Abstract

Background: We investigated outcomes of coronary artery bypass grafting (CABG) with endoscopic vein harvest (EVH) vs open vein harvest (OVH) within the Evaluation of XIENCE Versus CABG (EXCEL) trial. Methods: All patients in EXCEL randomized to CABG were included in this study. For this analysis, the primary end points were ischemia-driven revascularization (IDR) and graft stenosis or occlusion at 5 years. Additional end points were as follows: a composite of death from any cause, stroke, or myocardial infarction; bleeding; blood product transfusion; major arrhythmia; and infection requiring antibiotics. Event rates were based on Kaplan-Meier estimates in time-to-first-event analyses. Results: Of the 957 patients randomized to CABG, 686 (71.7%) received at least 1 venous graft with 257 (37.5%) patients in the EVH group and 429 (62.5%) patients in the OVH group. At 5 years, IDR was higher (11.5% vs 6.7%; P = .047) in the EVH group. At 5 years, rates of graft stenosis or occlusion (9.7% vs 5.4%; P = .054) and the primary end point (17.4% vs 20.9%; P = .27) were similar. In-hospital bleeding (11.3% vs 13.8%; P = .35), in-hospital blood product transfusion (12.8% vs 13.1%; P = .94), and infection requiring antibiotics within 1 month (13.6% vs 16.8%; P = .27) were similar between EVH and OVH patients. Major arrhythmia in the hospital (19.8% vs 13.5%; P = .03) and within 1 month (21.8% vs 15.4%; P = .03) was higher in EVH patients. Conclusions: IDR at 5 years was higher in the EVH group. EVH and OVH patients had similar rates of graft stenosis or occlusion and the composite of death, stroke, or myocardial infarction at 5 years.

Original languageEnglish
Pages (from-to)72-78
Number of pages7
JournalAnnals of Thoracic Surgery
Volume115
Issue number1
Early online date10 Mar 2022
DOIs
Publication statusPublished - 1 Jan 2023

Bibliographical note

Funding Information:
Funding for this work was provided by Abbott Vascular. Dr Kappetein with Medtronic; Dr Stone discloses a financial relationship with Velomedix, Toray, Matrizyme, Miracor, TherOx, Reva, V-Wave, Vascular Dynamics, Ablative Solutions, Neovasc, Medical Development Technologies, Lupin Pharmaceuticals, MedFocus, Guided Delivery Systems, Micardia, Vascular Nanotransfer Technologies, Cagent, Qool Therapeutics, Caliber Therapeutics, Aria, and Biostar, and he reports that Columbia University receives royalties from Abbott Vascular for the sale of the MitraClip; Dr Sabik with Medtronic, the Sorin Group, and Abbott and Edwards Lifesciences; and Dr Serruys with Abbott, AstraZeneca, Biotronik, Cardialysis, GLG Research, Medtronic, Sinomedical Sciences Technology, Stentys France, Svelte Medical Systems, Volcano, and St. Jude Medical.

Funding Information:
Funding for this work was provided by Abbott Vascular .

Publisher Copyright:
© 2023 The Society of Thoracic Surgeons

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