Safety of Minimally Invasive Heart Bypass Technique Questioned

Media outlets are reporting that a popular coronary bypass technique could <"">increase a patient’s risk of dying or suffering a heart attack within three years following the procedure. The procedure type has been commonly used because, in the short term, patients are spared pain and problems, noted the Associated Press (AP); however, problems can occur later.

According to the AP, this is no small issue given that nearly a half-million—about 450,000—bypass surgeries are conducted in the United States annually, with the vast majority—75 percent—using the procedure in question.

The Wall Street Journal explained that study found that in the past ten years, surgeons are opting more-and-more for the popular method over the traditional method of extracting leg veins for grafts. The “minimally invasive,” or endoscopic, technique—which is the method at issue—“weaves a thin tube through a small” leg incision, said the Journal.

Scientists from Duke Clinical Research Institute, report that the minimally invasive technique can increase the risk of death and the chance for other “long-term complications,” said the Journal, which noted that 7.4 percent of those who underwent the surgery died verses 5.8 percent who underwent “traditional vein extraction.” Traditional vein extraction involves an ankle-to-groin incision. Exact cause of death is unknown, but the researchers believe there is a link to the type of vein-extraction employed, said the Journal. said that the research concluded that patients undergoing the endoscopic method were 22 percent likelier to suffer heart attacks, undergo repeat surgeries, or die, within the three-year period over those patients going through the more invasive, traditional surgery, citing the Duke University researchers. The findings appear in today’s edition of the New England Journal of Medicine.

“The increased risk of worse outcomes with endoscopic harvesting should be weighed against its known short-term benefits,” wrote John Alexander, quoted Dr. Alexander is a cardiologist at Duke University. Additional research is called for, according to Dr. Alexander.

The AP pointed out that the newer method involving “porthole” cuts and use of a small scope and other tools emerged about 13 years ago, noting that the problem—in part—could be a result of the damage to the vein from being pulled out of a small scope incision. “This is a very worrisome finding,” said Dr. Timothy Gardner, a heart surgeon at Christiana Care Health Services and former American Heart Association president, quoted the AP.

The Journal noted that International Society for Minimally Invasive Cardiothoracic Surgery recommended endoscopic harvesting in 2005 as the “standard of care in bypass surgeries.”

The researchers looked at 3,000 patients at over 100 sites nationwide who were part of another study testing an experimental drug, representing the largest study with the longest follow-up, to review endoscopic vein extraction, said the AP. The Journal explained that, beginning in 2002, of the 3,014 patients, 1,753 underwent endoscopic harvesting and 1,247 went through traditional harvesting.

The researchers wrote, quoted the Journal that, “We found that patients who underwent endoscopic harvesting had higher rates of vein-graft failure 12 to 18 months after [the bypass] and, more important, also had significantly worse clinical outcomes at three years, including higher mortality.”

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