Study Reveals Risk with Common Bypass Surgery Procedure

July 16, 2009— -- When surgeons need veins to replace clogged vessels in the heart, they often use a minimally invasive technique to remove veins from the patient's legs. But a new study suggests that so-called "keyhole surgery" may lead to a worse outcome for bypass surgery patients.

Three years after surgery, patients whose surgeons harvested leg veins using keyhole, or endoscopic, techniques had a higher risk of heart attacks, repeat surgeries and death than patients who underwent traditional "open" surgery to remove leg veins, according to a study by Dr. John Alexander of Duke University, published in the July 16 issue of the New England Journal of Medicine.

Alexander said his results suggest that open harvesting may be the best procedure for removing veins because the process is less damaging to the veins.

"If you've ever seen one of these [endoscopic] procedures, there's clearly more tugging on the vein and more rough handling of the vein when it's harvested," Alexander said.

The National Center for Health Statistics estimates that in 2006, 448,000 coronary artery bypass procedures were performed on 253,000 patients in the United States, and endoscopic harvesting of vein has become the standard technique.

The analysis took a look at 1,753 bypass patients who had endoscopic harvesting and 1,247 who had graft harvesting under direct vision. A year to a year and a half after surgery, the rate of vein-graft failure resulting in repeat surgery, heart attack, or death was 47 percent among the patients who received endoscopically harvested veins versus only 38 percent in the open surgery group.

In recent years, minimally invasive methods have largely become the standard of care because of advantages such as less pain, shorter hospital stays and substantially smaller scars.