Acquired cardiovascular disease
Impact of endoscopic versus open saphenous vein harvest technique on late coronary artery bypass grafting patient outcomes in the ROOBY (Randomized On/Off Bypass) Trial

Read at the 90th Annual Meeting of the American Association for Thoracic Surgery, Toronto, Ontario, Canada, May 1–5, 2010.
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Objective

In the Randomized On/Off Bypass (ROOBY) Trial, the efficacy of on-pump versus off-pump coronary artery bypass grafting was evaluated. This ROOBY Trial planned subanalysis compared the effects on postbypass patient clinical outcomes and graft patency of endoscopic vein harvesting and open vein harvesting.

Methods

From April 2003 to April 2007, the technique used for saphenous vein graft harvesting was recorded in 1471 cases. Of these, 894 patients (341 endoscopic harvest and 553 open harvest) also underwent coronary angiography 1 year after coronary artery bypass grafting. Univariate and multivariable analyses were used to compare patient outcomes in the endoscopic and open groups.

Results

Preoperative patient characteristics were statistically similar between the endoscopic and open groups. Endoscopic vein harvest was used in 38% of the cases. There were no significant differences in both short-term and 1-year composite outcomes between the endoscopic and open groups. For patients with 1-year catheterization follow-up (n = 894), the saphenous vein graft patency rate for the endoscopic group was lower than that in the open harvest group (74.5% vs 85.2%, P < .0001), and the repeat revascularization rate was significantly higher (6.7% vs 3.4%, P < .05). Multivariable regression documented no interaction effect between endoscopic approach and off-pump treatment.

Conclusions

In the ROOBY Trial, endoscopic vein harvest was associated with lower 1-year saphenous vein graft patency and higher 1-year revascularization rates, independent of the use of off-pump or on-pump cardiac surgical approach.

CTSNet classification

23.1.4
23.1.5

Abbreviations and Acronyms

sCABG
coronary artery bypass grafting
EPIC
Evaluation of the PAS-Port in Coronary Surgery [trial]
EVH
endoscopic greater saphenous vein graft harvest
OVH
open greater saphenous vein graft harvest
PREVENT IV
Project of Ex-vivo Vein Graft Engineering via Transfection IV [trial]
ROOBY
Randomized On/Off Bypass [trial]
SVG
saphenous vein graft
VA
Veterans Affairs

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Supported by the Cooperative Studies Program of the Department of Veterans Affairs, Office of Research and Development, and by the Department of Veterans Affairs Central Office, Office of Patient Care Services, Washington, DC.

Disclosures: Authors have nothing to disclose with regard to commercial support.