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Vein Removal Method Linked to Bypass Results
Date:7/15/2009

months), death or heart attack (9.3 percent versus 7.6 percent at three years) and deaths (7.4 percent versus 5.8 percent at three years) seen in those who had endoscopic harvesting.

"This has changed the conversation I have with patients," said Alexander, who does not perform bypass surgery but refers patients for the procedure. "Now we have to be balancing the known short-term benefits of endoscopic harvesting with the long-term risk."

So far, he said, "most patients are still leaning toward having endoscopic harvesting and most surgeons are leaning toward endoscopic harvesting."

People who are candidates for bypass surgery most likely will not be having a conversation with their surgeons about the method of vein removal, Alexander said. Data from the study indicate that "hospitals and surgeons have their preferred technique," and that technique most often is endoscopic harvesting.

"This paper will likely stimulate discussion among surgeons," Alexander said. "But it will not be easy to change standard practice. And it is difficult in our health system to shop around, and I'm not certain it's the right thing to do."

"We have a conundrum," said Dr. T. Bruce Ferguson, chairman of cardiovascular sciences at the East Carolina Heart Institute, a member of the research team. "A technique which is technically more difficult to do but is done more often because it is better for patients now has been linked to outcome in a way that suggests we need to figure out how to improve endoscopic vein harvesting."

The study disclosed "an association, not a direct cause-and-effect relationship," Ferguson said. "The dominos appear to be in a straight line, but we don't know if they are supposed to be that way or just appear to be that way."

There is no obvious solution to the conundrum, he said. "It is incumbent on the cardiac surgical community to determine how to impact the risk-benefit equation so that we elimin
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