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Popular heart bypass technique may pose risk

A common method used in heart bypass surgery spares patients pain and problems upfront but seems to raise their risk of dying or suffering a heart attack over the next three years.

In heart bypass surgery, doctors remove a leg vein that moved to the chest to create detours around clogged heart arteries.

For decades, the leg vein was removed with a long incision — sometimes groin to toe. This technique referred to as “open harvesting” is painful, leaves big scars and often led to infections and longer hospital stays.

About 13 years ago, doctors began using a new way by making small “porthole” cuts and using a tiny scope and tools to tunnel along the vein and pull it out through the small openings. This technique, “endoscopic harvesting,” is very popular. Of the approximately 450,000 bypass operations done each year in the US, 70 percent use the less invasive method.

However, the study recently published in the New England Journal of Medicine found that patients treated with the endoscopic harvesting method were significantly more likely to die, suffer a heart attack or need another artery-opening procedure in the following three years. The likely reason is that the vein suffers damage from being pulled out, so it doesn’t hold up well over time.

The study involved 3,000 patients at more than 100 sites around the country who had been part of another study testing an experimental drug. Because its primary aim wasn’t to evaluate the leg artery removal technique, the results on the endoscopic harvesting method are not definitive.

More than 9 percent of people whose veins were removed with the newer endoscopic harvesting method died or suffered a heart attack in the following three years, versus fewer than 8 percent of those who had the traditional big incision.

More research is needed to confirm the results, but doctors probably should use the technique more sparingly or handle the vein more carefully when they do pull it out.

For more information please see: New England Journal of Medicine Article

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