Mid-term outcomes of endoscopic vein harvesting in coronary artery bypass graft: A retrospective cohort study

Mid-term outcomes of endoscopic vein harvesting in coronary artery bypass graft: A retrospective cohort study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Mid-term outcomes of endoscopic vein harvesting in coronary artery bypass graft: A retrospective cohort study Wuwei Wang, Yiming Liu, Haoyu Qi, Yafeng Liu, Yunfei Jiang, Rui Fan, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4181365/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 13 You are reading this latest preprint version Abstract OBJECTIVES Endoscopic vein harvesting (EVH) is an alternative technique to obtain the saphenous vein for coronary artery bypass graft (CABG) surgery. We aimed to evaluate the early and mid-term outcomes of patients with EVH in CABG. METHODS This cohort study included consecutive isolated CABG patients in Nanjing First Hospital from July 2020 to December 2022 using propensity score matching methods. Patients were classified to EVH group and open vein harvesting (OVH) group according to the vein harvesting methods. The primary outcome was the all-cause death, and the secondary outcomes were major adverse cardiovascular events (MACEs) including cardiovascular death, heart failure, myocardial infarction and revascularization and asymptomatic survival in the follow-up. RESULTS Totally 1247 patients were included in the study with 849 in OVH group and 398 in EVH group. Patients with EVH were more female, diabetes, higher body mass index, more multi-vessel and left main diseases. 308 pairs were formed after the matching. There was no significant difference in the rates of in-hospital death (EVH vs. OVH, 2.3% vs. 1.3%, P = 0.543). During the 3 years follow-up, EVH grafts were considered not inferior to OVH grafts, no differences were found in all-cause death [8.5% vs. 5.0%, hazard ratio (HR) 1.565, 95% confidence interval (CI): 0.77–3.17, P = 0.21], MACEs (8.1% vs. 7.1%, HR 1.165, 95CI: 0.51–2.69, P = 0.71) and asymptomatic survival (66.7% vs. 72.5%, HR 1.117, 95%CI: 0.65–1.92, P = 0.68). CONCLUSIONS EVH grafts were considered comparable to OVH grafts in patients following CABG in the 3 years follow-up. Endoscopic vein harvesting Open vein harvesting coronary artery bypass grafting Prognosis Figures Figure 1 Figure 2 Background Coronary artery bypass graft (CABG) surgery is a common procedure in the treatment of multi-vessel coronary artery disease [ 1 ] . From the data of Chinese Cardiac Surgery Registry, there are over 10000 CABGs performed per year [ 2 ] . Although totally arterial CABG shown better prognosis in the long-term follow-up, the saphenous vein is still the most commonly used graft second only to the left internal mammary artery (LIMA) currently. Open vein harvesting (OVH) was the traditionally technique to obtain the saphenous veins for CABG surgery. Its simple operation and short learn curve are favored by surgeons, however meanwhile, OVH has several drawbacks including postoperative pain, wound complication and increased risk of infection [ 3 – 5 ] . Endoscopic vein harvesting (EVH) has become an alternative technique and widely used in decades due to its substantial decrease in postoperative leg wound complications. The ESC/EACTS [ 6 ] and ACC/AHA/SCIA [ 1 ] guidelines for coronary artery revascularization both recommend the use of EVH in CABG to reduce the wound complications. In the previous studies, the EVH technique has been shown to significantly reduce wound-related complications, decrease postoperative pain and increase patient satisfaction comparing with OVH [ 7 ] . A large randomized control trail (REGROUP Trial) on western countries showed no significant differences in the risk of major adverse cardiac events [ 8 ] . However, its safety evidence in different race were still limited especially in Asian populations. Several researches had shown that endoscopic technique may cause the excessive stretching and potential tears or avulsions of saphenous vein, which incite early graft atherosclerosis and failure [ 9 ] . Therefore, the aim of this cohort study is to compare the outcomes of OVH and EVH in CABG surgery in the early and mid-term follow-up in Chinese population. Methods Patients This cohort study included consecutive patients who underwent primary isolated CABG at Nanjing First Hospital, a level A tertiary hospital located in Jiangsu Province, China, between July 2020 to December 2022. The study was approved by the ethics committee of Nanjing First Hospital for the data collection (KY20170811-03) and the written informed consent was not required because of the nature of the study. The exclusion criteria included the following: 1) concomitant procedures, including valve surgery, aorta surgery, congenital heart diseases surgery, Maze procedure, ventricular aneurysm surgery and other surgeries. 2) previous CABG procedure. 3) no saphenous vein use in the surgery. 4) missing vein graft data patients. All eligible patients were classified into EVH group and OVH group according to the different method of vein harvesting. Clinical data including medical history, procedural details and clinical outcomes were collected through the specific multi-center databases of Cardiovascular Surgery Department in Jiangsu Province. Surgical procedures After general anesthesia, all patients received a median sternotomy. Skeletonized or pedicled LIMA was obtained as a graft to left anterior descending artery. The decision to perform either EVH or OVH procedure was taken individually by each treatment group. Patients with open vein harvesting were often made an incision started at the ankle. The subcutaneous tissue was dissected to expose the greater saphenous vein and then extended upward the skin incision alone the course of the vein. While, a 2-3cm transverse incision was made over the vessel at the knee for patients with endoscopic vein harvesting. Using a blunt conical as a dissecting tool to push tissues off the vein and then change it into a clamp to cauterize and divide the side branches. incisions were made separately at the groin and the ankle to divide the end of the vein. All EVH procedures were conducted by a specific surgeon with more than 2 years surgical experience and over 50 surgeries per year. The coronary artery anastomosis was conducted with or without cardiopulmonary bypass. Transit time flow measurement (TTFM) was used to control the quality of CABG before chest closure with mean arterial pressure ≥ 80 mmHg [ 10 ] . Outcomes The primary outcome of this study was all-cause mortality from the surgical time to the endpoint follow-up. The secondary outcomes were major adverse cardiovascular events (MACEs) and asymptomatic survival in the mid-term follow-up. MACEs were defined as the cardiac-cause death, heart failure, myocardial infarction and revascularization. The post-operative follow-up was conducted by Cardiovascular Surgery Follow-up Group in Nanjing First Hospital at 1,3,6,12 month and per year after the surgery. Direct telephone monitoring was used to confirm survival and MACEs for the final follow-up form April to June 2023. For those who lost to follow-up, the last recorded data were used. Statistical analysis Continuous variables are presented as mean(SD) or median(interquartile range[IQR]) according to the data distribution. The student t test or Mann-Whitney U-test were applied to normally and non-normally distributed variables separately. Categorical data are presented as frequencies and percentages and were compared using chi-square test or Fisher’s exact probability method. Propensity score matching was used to reduce the impact of potential confounders. The propensity scores were calculated using logistic regression, taking into account the demographic and clinical characteristics mentioned in Table 1 . Patients underwent OVH were matched to patients with EVH using the propensity score with 1:1 greedy nearest neighbor matching with a caliper of 0.02 [ 11 ] . Standardized mean differences(SMDs) < 0.1 were considered to be an indicator of ideal balance between groups [ 12 ] . This method functionally relied on the R package MatchIt. Table 1 Baseline characteristics before and after PS matching between OVH and EVH group. Before PS matching After PS matching OVH(n = 849) EVH(n = 398) SMD OVH(n = 308) EVH(n = 308) SMD Age, mean(SD) 64.55(9.58) 65.08(10.03) 0.053 64.13(9.57) 64.39(10.13) 0.026 Male, n(%) 630(74.2) 267(67.1) 0.152 215(69.8) 222(72.1) 0.048 BMI, mean(SD) 24.58(3.17) 25.14(3.39) 0.166 25.01(3.21) 25.05(3.33) 0.012 Smoke, n(%) 387(45.6) 188(47.2) 0.033 145(47.1) 148(48.1) 0.020 Hypertension, n(%) 584(68.8) 295(74.1) 0.122 220(71.4) 224(72.7) 0.030 Diabetes, n(%) 371(43.7) 188(47.2) 0.071 136(44.2) 144(46.8) 0.052 Hyperlipidemia 156(18.4) 144(36.2) 0.371 86(27.9) 73(23.7) 0.088 COPD, n(%) 29(3.4) 8(2.0) 0.100 9(2.9) 7(2.3) 0.046 PAD, n(%) 30(3.5) 30(7.5) 0.152 13(4.2) 16(5.2) 0.037 CAS, n(%) 88(10.4) 49(12.3) 0.059 29(9.4) 34(11.0) 0.069 Previous Stoke, n(%) 92(10.8) 53(13.3) 0.073 43(14.0) 40(13.0) 0.029 Previous PCI, n(%) 108(12.7) 38(9.5) 0.108 30(9.7) 32(10.4) 0.022 eGFR, mean(SD), ml/(min•1.73m 2 ) 92.57(28.49) 91.75 (30.22) 0.027 93.77(30.18) 92.94(30.28) 0.028 eGFR < 90ml/(min•1.73m 2 ) 382(45.0) 184(46.2) 0.025 136(44.2) 139(45.1) 0.020 Angina, n(%) 738(86.9) 340(85.4) 0.486 263(85.4) 261(84.7) 0.018 ACS, n(%) 242(28.6) 206(52.6) 0.480 135(43.8) 137(44.5) 0.013 NYHA III-IV, n(%) 276(32.5) 86(21.6) 0.265 77(25.0) 77(25.0) 0.000 LVEF, mean(SD), % 58.01(9.96) 58.12(10.03) 0.011 58.45(9.32) 57.86(10.06) 0.059 LVEF < 50%, n(%) 188(22.1) 87(21.9) 0.007 66(21.4) 70(22.7) 0.031 3 vessel disease, n(%) 723(85.2) 380(95.5) 0.497 288(93.5) 290(94.2) 0.031 LM disease, n(%) 257(30.3) 144(36.2) 0.123 101(32.8) 105(34.1) 0.027 Emergency, n(%) 33(3.9) 16(4.0) 0.007 15(4.9) 15(4.9) 0.000 EuroSCORE II, mean(SD), % 2.00(2.39) 2.60(3.47) 0.174 2.04(1.93) 2.26(2.24) 0.065 Values are presented as mean(SD) or frequency(percentage). PS: propensity score. OVH: open vein harvesting. EVH: endoscopic vein harvesting. SMD: standardized mean difference. BMI: body mass index. COPD: chronic obstructive pulmonary disease. PAD: peripheral arterial disease. CAS: carotid stenosis. PCI: percutaneous coronary intervention. eGFR: estimated glomerular filtration rate. ACS: acute coronary syndrome. NYHA: New York heart association. LVEF: left ventricular ejection fractions. LM: left main artery. Time-to-events were computed using Kaplan-Meier survival curves. Log-rank statistics was used to test the differences of mortality after the PSM cohorts. Because of the competing risk of mortality to observe the MACEs and asymptomatic survival probabilities, the Fine-Gray contrast method was used to compared the differences. Hazard ratios (HRs) and 95% confidences intervals (CIs) were used to assess the proportional hazard assumption. All statistical analyses were performed using R software, version 4.2.2( http://www.r-project.org/ ). A two-side P value < 0.05 was considered statistically significant Results Baseline characteristics There were 1867 patients who underwent CABG from July 2020 to December 2022 in Nanjing First Hospital. Of which 1309 patients got isolate CABG for first time (Detailed excluding process is shown in Fig. 1 .). Totally 1247 patients used saphenous vein including 849 with OVH and 398 with EVH. In the original cohort, EVH group had a higher proportion of female, hypertension, hyperlipidemia, peripheral arterial disease(PAD), history of PCI, angina and acute coronary syndrome(all P < 0.05), meanwhile patients in EVH group had a higher body mass index(BMI), more 3 vessel disease and left main disease. After propensity score matching, 308 pairs successfully matched with baseline SMDs < 0.1 for all baseline characteristics(Table 1 ). In-hospital outcomes The surgical information and postoperative in-hospital outcomes in the PSM groups are shown in Table 2 . With the surgical information, patients in the EVH group had more numbers of vein graft (3 vs. 2, P < 0.001) and the OVH group had more intraoperative blood transfusion (19.5% vs. 35.3%, P < 0.001). There were no significant differences in operating time, CPB use and LIMA use between cohorts. EVH patients had more rates of acute kidney injury (8.5% vs. 4.2%, P = 0.045) and less prolonged mechanical ventilation (4.9% vs. 10.1%, P = 0.023). Death in hospital rates (2.3% vs. 1.3%, P = 0.543) and other in hospital postoperative outcomes (ICU stay time, low cardiac output, cardiac arrest, reoperation for bleeding and cerebral vascular accident) did not show the differences in the groups. The similar tendencies were observed between the cohorts before propensity matching (Supplementary Material, Table S1 .) Table 2 Surgical information and postoperative in hospital outcomes in propensity matched patients with open vein harvesting and endoscopic vein harvesting. EVH group (n = 308) OVH group (n = 308) P value Operating time, median(IQR), min 260(230,300) 265(225,300) 0.635 Cardiopulmonary bypass use, n(%) 264(85.7) 264(85.7) 0.840 CPB time, median(IQR), min 97(80,117) 96(82,115) 0.573 ACC time, median(IQR), min 62(50,77) 63(51,79) 0.756 Use of LIMA, n(%) 297(96.4) 297(96.4) 1.000 Numbers of vein graft, median(IQR), min 3(2,3) 2(3,4) < 0.001 Intraoperative blood transfusion, n(%) 57(19.5) 108(35.3) < 0.001 ICU time, median(IQR), day 1(1,2) 1(1,2) 0.119 Low cardiac output, n(%) 10(3.3) 12(3.9) 0.840 Cardiac arrest, n(%) 3(1.0) 3(1.0) 1.000 Reoperation for bleeding, n(%) 3(1.0) 5(1.6) 0.725 Readmitted to ICU, n(%) 6(1.9) 8(2.6) 0.787 Acute kidney injury, n(%) 26(8.5) 13(4.2) 0.045 Prolonged mechanical ventilation, n(%) 15(4.9) 31(10.1) 0.023 Cerebral vascular accident, n(%) 13(4.3) 16(5.2) 0.717 Death in hospital, n(%) 7(2.3) 4(1.3) 0.543 OVH: open vein harvesting. EVH: endoscopic vein harvesting. IQR: interquartile range. CPB: cardiopulmonary bypass. ACC: aortic cross clamping. LIMA: left internal mammary artery. Table 3 Intraoperative transit time flow measurement between endoscopic and open vein harvesting patients in different target vessels. Target vessel Variables EVH group Mean(SD) OVH group Mean(SD) Difference* 95% CI P -value LAD systems (n = 173, 133) MGF 35.2 (17.99) 34.4 (19.53) 0.56 -3.66, 4.78 0.796 PI 2.0 (1.08) 2.6 (3.59) -0.57 -1.14, -0.01 0.049 LCX systems (n = 228, 183) MGF 42.1 (26.32) 36.6 (26.87) 4.43 -0.65, 9.51 0.088 PI 2.2 (1.22) 2.5 (1.69) -0.27 -0.55, 0.01 0.062 RCA systems (n = 263, 209) MGF 40.4 (24.45) 36.4 (21.08) 3.41 -0.75, 7.57 0.109 PI 2.5 (2.12) 2.3 (1.86) 0.26 -0.11, 0.62 0.170 Total (n = 664, 525) MGF 39.6 (23.76) 35.9 (22.89) 3.10 0.45, 5.75 0.022 PI 2.3 (1.62) 2.4 (2.37) -0.14 -0.36, 0.09 0.240 *The differences were adjusted for the diameters of corresponding target vessel. MGF: mL/min EVH: endoscopic vein harvesting. OVH: open vein harvesting. CI: confidence interval. MGF: mean graft flow. PI: pulsatility index. TTFM results in CABG All patients received intraoperative TTFM during the surgery. There are totally 1189 saphenous vein grafts(SVGs) from 616 patients could be counted(664 in EVH group and 525 in OVH group). Depending on differences of the target vessels, we categorized them as LAD system(including LAD, Diagonal), LCX system(including OM) and RCA system(including RCA, PL and PDA). Most SVGs showed well fluency with the averages of MGF over 30mL/min and PI < 3.0. The EVH grafts had higher MGF(39.6 mL/min vs. 35.9 mL/min, P = 0.022) than OVH grafts with nearly the same PI(2.3 vs. 2.4, P = 0.240). There were no significant differences in MGF between groups when categorize the SVGs with target vessels. Survival analysis There were 19 patients who had in-hospital death with 10 in EVH group. The main reason of in-hospital death was ventricular arrhythmia(42.1%, 5/10 in EVH group, 4/9 in OVH group). The median (interquartile range) follow-up time was 1.5 (1.0–2.0) years in EVH cohort and 1.67 (1.0-2.25) years in OVH cohorts. Totally 28 patients were lost to follow-up (2.0%), and no significant difference was found between 2 cohorts (2.5% vs. 1.6%, P = 0.301). The all-cause death rate had no significant difference in different vein harvesting during the 3 years follow-up. The rate of death from all cause was 8.5% in EVH cohort vs 5.0% in OVH cohort (HR 1.565, 95%CI: 0.77–3.17, Log-rank P = 0.21) (Fig. 2 A). After adjusting for death from non-cardiovascular causes as a competing risk, death from cardiovascular causes was 1.7% in EVH group vs 2.5% in OVH group(HR 0.769, 95%CI: 0.25–2.39, Log-rank P = 0.65)(Fig. 2 B). As the secondary outcomes, no significant differences were observed in the incidence of MACEs(8.1% vs. 7.1%, HR 1.165, 95CI: 0.51–2.69, Log-rank P = 0.71)(Fig. 2 C) and asymptomatic survival(66.7% vs. 72.5%, HR 1.117, 95%CI: 0.65–1.92, Log-rank P = 0.68)(Fig. 2 D) after adjusting death as a competing risk. The same results were observed in the original cohorts (Figure S1 ). Discussion In this retrospective cohort study, we found that comparing with open vein harvesting, the grafts conducted by endoscopic vein harvesting showed the comparable prognosis in isolated CABG patients in 3 years follow-up with the similar morality, rates of MACEs and asymptomatic survival. As well, female, obese, diabetic and multi-vessel patients are more reasonable to use EVH when conducting CABG surgery. EVH method have evolved rapidly and been widely used in the last two decades because of its smaller incisions. About 50–70% patients with CABG use EVH to conducts the vein grafts in western countries [ 13 , 14 ] . In this study, EVH was performed in 32.0% patients which had a smaller percentage comparing with some previous studies. EVH is associated with a learn curve and the saphenous vein conducted by inexperienced surgeons could cause the early graft failure [ 15 ] . In this research, the EVH procedure was conducted by an experienced surgeon(Professor Shao.) to decrease the bias caused by the surgery. Two subgroup analysis of the clinical trials(PREVENT IV Trial and ROOBY Trial) suggested that EVH was associated with higher rates of vein graft failure and repeat revascularization [ 16 , 17 ] . However, these two RCTs were conducted 10 years ago and were not designed to compare the outcomes of EVH and OVH technique. REGROUP Trial [ 8 ] was the first randomized trial to describe the outcomes between EVH and OVH in western countries. In our study, we compare the early and mid-term prognosis of EVH grafts which showed that there were no significant differences in the rates of all-cause death and MACEs in 3 years after the CABG surgery comparing with OVH groups. This is consistent with the results of several recent retrospective studies [ 18 – 20 ] and REGROUP Trial. Currently, TTFM was more confirmed the association with graft patency and postoperative clinical outcomes [ 10 ] . Early graft failure occurred predominantly in SVGs with lower MGF and higher PI [ 21 , 22 ] . In this study, most vein grafts measured by TTFM during the surgery. The MGF of all vein graft counted were over 31 ml/min, which was considered as a risk factor of early graft failure [ 23 ] . Meanwhile, we found that EVH grafts showed a higher MGF than OVH grafts and the PI between cohorts had no significant differences which suggested that appropriately stretching SV in EVH technique may not have the immediate effect on MGF in the surgery. This could also explain that similar prognosis in the early and mid-term follow-up. There are still several limitations of this research. Firstly, this study was a single-center retrospective cohort study, some potential biases could not be fully avoided and a multicenter randomized controlled study could be more convincing. Secondly, EVH procedures were conducted by the same experience surgeon, however, the OVH were performed by different surgeons in our center, which could affect the efficiency of treatment in OVH group. Conclusion In this cohort study from East China, EVH shows a similar in-hospital outcomes comparing with OVH. Also, in the 3 years follow-up, EVH is not associated with worse clinic outcomes(all-cause death, MACEs) to OVH. Longer follow-up need to be conducted further to evaluate the long-term prognosis of EVH additionally. Abbreviations and Acronyms CABG = coronary artery bypass graft EVH = endoscopic vein harvesting LIMA = left internal mammary artery MACEs = major adverse cardiovascular events OVH = open vein harvesting TTFM = transit time flow measurement Declarations Acknowledges Not applicable. Authors’ contributions W.W and H.Q wrote the main manuscript text, Yi.L ,Ya.L and Y.J contributed to the data curation.Yi.L J.S and W.C contributed to the methodology. W.W and R.F did the formal analysis. C.S and X.C contributed to the project administration. All authors reviewed the whole manuscript. Funding No funding. Ethics approval and consent to participate The study was approved by the ethics committee of Nanjing First Hospital(Nanjing, Jiangsu, Republic of China.)for the data collection (KY20170811-03) and individual consent for this retrospective analysis was waived. Consent for publication Written consent for publication was obtained from patients. 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Supplementary Files Supplementarymaterial.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 25 May, 2024 Reviews received at journal 18 May, 2024 Reviews received at journal 17 May, 2024 Reviewers agreed at journal 08 May, 2024 Reviews received at journal 07 May, 2024 Reviews received at journal 04 May, 2024 Reviewers agreed at journal 03 May, 2024 Reviewers agreed at journal 01 May, 2024 Reviewers agreed at journal 01 May, 2024 Reviewers invited by journal 01 May, 2024 Submission checks completed at journal 02 Apr, 2024 Editor assigned by journal 02 Apr, 2024 First submitted to journal 28 Mar, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4181365","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":286854522,"identity":"b5b98e57-afdc-40f2-88d6-dc925a428149","order_by":0,"name":"Wuwei Wang","email":"","orcid":"","institution":"Nanjing First Hospital","correspondingAuthor":false,"prefix":"","firstName":"Wuwei","middleName":"","lastName":"Wang","suffix":""},{"id":286854523,"identity":"8392ae5a-459f-4856-b905-b6a4cc4d5d27","order_by":1,"name":"Yiming Liu","email":"","orcid":"","institution":"Nanjing First Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yiming","middleName":"","lastName":"Liu","suffix":""},{"id":286854524,"identity":"f89c0611-9040-437b-a4be-0ce54f43b8a8","order_by":2,"name":"Haoyu Qi","email":"","orcid":"","institution":"Nanjing First Hospital","correspondingAuthor":false,"prefix":"","firstName":"Haoyu","middleName":"","lastName":"Qi","suffix":""},{"id":286854525,"identity":"19c13b9f-9d92-4149-95ee-671bf9a7a3c3","order_by":3,"name":"Yafeng Liu","email":"","orcid":"","institution":"Nanjing First Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yafeng","middleName":"","lastName":"Liu","suffix":""},{"id":286854526,"identity":"61ec868c-7c53-434c-9c8a-daa27f401868","order_by":4,"name":"Yunfei Jiang","email":"","orcid":"","institution":"Nanjing First Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yunfei","middleName":"","lastName":"Jiang","suffix":""},{"id":286854527,"identity":"fecf4569-dcce-46ab-9e69-cf902ade48f4","order_by":5,"name":"Rui Fan","email":"","orcid":"","institution":"Nanjing First Hospital","correspondingAuthor":false,"prefix":"","firstName":"Rui","middleName":"","lastName":"Fan","suffix":""},{"id":286854528,"identity":"48306c7a-bb86-42cc-a7b3-7a36bfe87517","order_by":6,"name":"Junjie Shao","email":"","orcid":"","institution":"Nanjing First Hospital","correspondingAuthor":false,"prefix":"","firstName":"Junjie","middleName":"","lastName":"Shao","suffix":""},{"id":286854529,"identity":"cdf59a7f-d70b-43e1-928d-b5a24e08e00c","order_by":7,"name":"Wen Chen","email":"","orcid":"","institution":"Nanjing First Hospital","correspondingAuthor":false,"prefix":"","firstName":"Wen","middleName":"","lastName":"Chen","suffix":""},{"id":286854530,"identity":"a8a5d824-276f-4586-9cbb-3c1cf4ec1ecb","order_by":8,"name":"Cunhua Su","email":"","orcid":"","institution":"Nanjing First Hospital","correspondingAuthor":false,"prefix":"","firstName":"Cunhua","middleName":"","lastName":"Su","suffix":""},{"id":286854531,"identity":"743aa790-5466-4a78-a5c7-761e75be9275","order_by":9,"name":"Xin Chen","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0klEQVRIiWNgGAWjYBADOQaGAyCamQi1bBDKmHQtiQ0Qmggt8vObj0l8qDmcvp3xdJoEQ4V1YgP72QN4tRgcY0uTnHEsLXdnw9ltEgxn0hMbePIS8Gth4zE25m2wyd1wAKiFse1wYoMEjwF+h7Xxfzb+2yCRbgDW8o8ILQzHeBgfMzbYJEC0NBChxeBYmuHDHiABdNhmi4Rj6cZtPDkEHNZ8+MGBHzWH5Q1unN1440ONtWw/+xkCDoMDiQMMDAkM8IgiBvA3EK92FIyCUTAKRhYAAFpHRvTUiylVAAAAAElFTkSuQmCC","orcid":"","institution":"Nanjing First Hospital","correspondingAuthor":true,"prefix":"","firstName":"Xin","middleName":"","lastName":"Chen","suffix":""}],"badges":[],"createdAt":"2024-03-28 10:05:49","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4181365/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4181365/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":54320381,"identity":"4d92ef92-b1d7-494e-b138-c79647f38b04","added_by":"auto","created_at":"2024-04-08 19:10:17","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":182874,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFlowchart of the study.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCABG: coronary artery bypass graft. OVH: open vein harvesting. EVH: endoscope vein harvesting.\u003c/p\u003e","description":"","filename":"figure1flowchart.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4181365/v1/4b75c54f1a9d90658d6e433a.jpg"},{"id":54320382,"identity":"6c58f65c-d7b0-4ea4-9df6-0448429218df","added_by":"auto","created_at":"2024-04-08 19:10:17","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":701656,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSurvival curves at the mid-term follow-up.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCumulative incidence curves illustrating the mid-outcomes of the rates of all-cause death (A) , cardiovascular death (C) and MACEs (B) in the propensity matched cohort of EVH (blue) and OVH (red) group. Kaplan-Meier curves showing the mid-outcomes of overall asymptomatic survival (D) between two groups. No significant differences were observed between EVH and OVH groups in mid-outcome rate of all-cause death (log-rank \u003cem\u003eP\u003c/em\u003e=0.21) , cardiovascular death (log-rank P=0.65) . After the competing risk model, there were also no difference in MACEs (log-rank \u003cem\u003eP\u003c/em\u003e=0.71) and asymptomatic survival (log-rank \u003cem\u003eP\u003c/em\u003e=0.68) in mid-term follow-up showed no difference.\u003c/p\u003e\n\u003cp\u003eHR: hazard ratio. CI: confidence interval. EVH: endoscopic vein harvesting. OVH: open vein harvesting. MACEs: major adverse of cardiovascular events.\u003c/p\u003e","description":"","filename":"figure2survivalplotafterPS.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4181365/v1/4931744f43d59efa164dfffe.jpg"},{"id":54320722,"identity":"0bc7a126-a6dd-4afd-b3df-ddcb7ae500ab","added_by":"auto","created_at":"2024-04-08 19:18:18","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":467672,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4181365/v1/9f93a964-1499-4b50-8671-664c86038dea.pdf"},{"id":54320383,"identity":"bc1fa18a-a44b-4b40-8942-2524ebfa93b0","added_by":"auto","created_at":"2024-04-08 19:10:17","extension":"docx","order_by":7,"title":"","display":"","copyAsset":false,"role":"supplement","size":250160,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementarymaterial.docx","url":"https://assets-eu.researchsquare.com/files/rs-4181365/v1/70625c21e3dee3555dba8fb7.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Mid-term outcomes of endoscopic vein harvesting in coronary artery bypass graft: A retrospective cohort study","fulltext":[{"header":"Background","content":"\u003cp\u003eCoronary artery bypass graft (CABG) surgery is a common procedure in the treatment of multi-vessel coronary artery disease\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. From the data of Chinese Cardiac Surgery Registry, there are over 10000 CABGs performed per year\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. Although totally arterial CABG shown better prognosis in the long-term follow-up, the saphenous vein is still the most commonly used graft second only to the left internal mammary artery (LIMA) currently.\u003c/p\u003e \u003cp\u003eOpen vein harvesting (OVH) was the traditionally technique to obtain the saphenous veins for CABG surgery. Its simple operation and short learn curve are favored by surgeons, however meanwhile, OVH has several drawbacks including postoperative pain, wound complication and increased risk of infection\u003csup\u003e[\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. Endoscopic vein harvesting (EVH) has become an alternative technique and widely used in decades due to its substantial decrease in postoperative leg wound complications. The ESC/EACTS\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e and ACC/AHA/SCIA\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e guidelines for coronary artery revascularization both recommend the use of EVH in CABG to reduce the wound complications.\u003c/p\u003e \u003cp\u003eIn the previous studies, the EVH technique has been shown to significantly reduce wound-related complications, decrease postoperative pain and increase patient satisfaction comparing with OVH\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. A large randomized control trail (REGROUP Trial) on western countries showed no significant differences in the risk of major adverse cardiac events\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e. However, its safety evidence in different race were still limited especially in Asian populations. Several researches had shown that endoscopic technique may cause the excessive stretching and potential tears or avulsions of saphenous vein, which incite early graft atherosclerosis and failure\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. Therefore, the aim of this cohort study is to compare the outcomes of OVH and EVH in CABG surgery in the early and mid-term follow-up in Chinese population.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003ePatients\u003c/p\u003e \u003cp\u003eThis cohort study included consecutive patients who underwent primary isolated CABG at Nanjing First Hospital, a level A tertiary hospital located in Jiangsu Province, China, between July 2020 to December 2022. The study was approved by the ethics committee of Nanjing First Hospital for the data collection (KY20170811-03) and the written informed consent was not required because of the nature of the study.\u003c/p\u003e \u003cp\u003eThe exclusion criteria included the following: 1) concomitant procedures, including valve surgery, aorta surgery, congenital heart diseases surgery, Maze procedure, ventricular aneurysm surgery and other surgeries. 2) previous CABG procedure. 3) no saphenous vein use in the surgery. 4) missing vein graft data patients. All eligible patients were classified into EVH group and OVH group according to the different method of vein harvesting. Clinical data including medical history, procedural details and clinical outcomes were collected through the specific multi-center databases of Cardiovascular Surgery Department in Jiangsu Province.\u003c/p\u003e \u003cp\u003eSurgical procedures\u003c/p\u003e \u003cp\u003eAfter general anesthesia, all patients received a median sternotomy. Skeletonized or pedicled LIMA was obtained as a graft to left anterior descending artery. The decision to perform either EVH or OVH procedure was taken individually by each treatment group. Patients with open vein harvesting were often made an incision started at the ankle. The subcutaneous tissue was dissected to expose the greater saphenous vein and then extended upward the skin incision alone the course of the vein. While, a 2-3cm transverse incision was made over the vessel at the knee for patients with endoscopic vein harvesting. Using a blunt conical as a dissecting tool to push tissues off the vein and then change it into a clamp to cauterize and divide the side branches. incisions were made separately at the groin and the ankle to divide the end of the vein. All EVH procedures were conducted by a specific surgeon with more than 2 years surgical experience and over 50 surgeries per year. The coronary artery anastomosis was conducted with or without cardiopulmonary bypass. Transit time flow measurement (TTFM) was used to control the quality of CABG before chest closure with mean arterial pressure\u0026thinsp;\u0026ge;\u0026thinsp;80 mmHg\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eOutcomes\u003c/p\u003e \u003cp\u003eThe primary outcome of this study was all-cause mortality from the surgical time to the endpoint follow-up. The secondary outcomes were major adverse cardiovascular events (MACEs) and asymptomatic survival in the mid-term follow-up. MACEs were defined as the cardiac-cause death, heart failure, myocardial infarction and revascularization. The post-operative follow-up was conducted by Cardiovascular Surgery Follow-up Group in Nanjing First Hospital at 1,3,6,12 month and per year after the surgery. Direct telephone monitoring was used to confirm survival and MACEs for the final follow-up form April to June 2023. For those who lost to follow-up, the last recorded data were used.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eContinuous variables are presented as mean(SD) or median(interquartile range[IQR]) according to the data distribution. The student t test or Mann-Whitney U-test were applied to normally and non-normally distributed variables separately. Categorical data are presented as frequencies and percentages and were compared using chi-square test or Fisher\u0026rsquo;s exact probability method.\u003c/p\u003e \u003cp\u003ePropensity score matching was used to reduce the impact of potential confounders. The propensity scores were calculated using logistic regression, taking into account the demographic and clinical characteristics mentioned in Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Patients underwent OVH were matched to patients with EVH using the propensity score with 1:1 greedy nearest neighbor matching with a caliper of 0.02\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. Standardized mean differences(SMDs)\u0026thinsp;\u0026lt;\u0026thinsp;0.1 were considered to be an indicator of ideal balance between groups\u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e. This method functionally relied on the R package MatchIt.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline characteristics before and after PS matching between OVH and EVH group.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eBefore PS matching\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e \u003cp\u003eAfter PS matching\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOVH(n\u0026thinsp;=\u0026thinsp;849)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEVH(n\u0026thinsp;=\u0026thinsp;398)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSMD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOVH(n\u0026thinsp;=\u0026thinsp;308)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eEVH(n\u0026thinsp;=\u0026thinsp;308)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eSMD\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, mean(SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e64.55(9.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65.08(10.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.053\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e64.13(9.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e64.39(10.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.026\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e630(74.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e267(67.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.152\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e215(69.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e222(72.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.048\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI, mean(SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24.58(3.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25.14(3.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.166\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e25.01(3.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e25.05(3.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.012\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoke, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e387(45.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e188(47.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.033\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e145(47.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e148(48.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.020\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e584(68.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e295(74.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.122\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e220(71.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e224(72.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.030\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e371(43.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e188(47.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.071\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e136(44.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e144(46.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.052\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHyperlipidemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e156(18.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e144(36.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.371\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e86(27.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e73(23.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.088\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCOPD, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29(3.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8(2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9(2.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7(2.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.046\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePAD, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30(3.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30(7.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.152\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13(4.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e16(5.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.037\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCAS, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e88(10.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49(12.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.059\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e29(9.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e34(11.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.069\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrevious Stoke, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e92(10.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53(13.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.073\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e43(14.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e40(13.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.029\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrevious PCI, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e108(12.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38(9.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.108\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e30(9.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e32(10.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.022\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eeGFR, mean(SD), ml/(min\u0026bull;1.73m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e92.57(28.49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e91.75 (30.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.027\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e93.77(30.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e92.94(30.28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.028\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eeGFR\u0026thinsp;\u0026lt;\u0026thinsp;90ml/(min\u0026bull;1.73m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e382(45.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e184(46.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.025\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e136(44.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e139(45.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.020\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAngina, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e738(86.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e340(85.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.486\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e263(85.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e261(84.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.018\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eACS, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e242(28.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e206(52.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.480\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e135(43.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e137(44.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.013\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNYHA III-IV, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e276(32.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e86(21.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.265\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e77(25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e77(25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLVEF, mean(SD), %\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58.01(9.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58.12(10.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e58.45(9.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e57.86(10.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.059\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLVEF\u0026thinsp;\u0026lt;\u0026thinsp;50%, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e188(22.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e87(21.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e66(21.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e70(22.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.031\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3 vessel disease, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e723(85.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e380(95.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.497\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e288(93.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e290(94.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.031\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLM disease, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e257(30.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e144(36.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.123\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e101(32.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e105(34.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.027\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmergency, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33(3.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16(4.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15(4.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e15(4.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEuroSCORE II, mean(SD), %\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.00(2.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.60(3.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.174\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.04(1.93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.26(2.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.065\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003eValues are presented as mean(SD) or frequency(percentage).\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003ePS: propensity score. OVH: open vein harvesting. EVH: endoscopic vein harvesting. SMD: standardized mean difference. BMI: body mass index. COPD: chronic obstructive pulmonary disease. PAD: peripheral arterial disease. CAS: carotid stenosis. PCI: percutaneous coronary intervention. eGFR: estimated glomerular filtration rate. ACS: acute coronary syndrome. NYHA: New York heart association. LVEF: left ventricular ejection fractions. LM: left main artery.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTime-to-events were computed using Kaplan-Meier survival curves. Log-rank statistics was used to test the differences of mortality after the PSM cohorts. Because of the competing risk of mortality to observe the MACEs and asymptomatic survival probabilities, the Fine-Gray contrast method was used to compared the differences. Hazard ratios (HRs) and 95% confidences intervals (CIs) were used to assess the proportional hazard assumption.\u003c/p\u003e \u003cp\u003eAll statistical analyses were performed using R software, version 4.2.2(\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.r-project.org/\u003c/span\u003e\u003cspan address=\"http://www.r-project.org/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e). A two-side \u003cem\u003eP\u003c/em\u003e value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eBaseline characteristics\u003c/p\u003e\n\u003cp\u003eThere were 1867 patients who underwent CABG from July 2020 to December 2022 in Nanjing First Hospital. Of which 1309 patients got isolate CABG for first time (Detailed excluding process is shown in Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.). Totally 1247 patients used saphenous vein including 849 with OVH and 398 with EVH. In the original cohort, EVH group had a higher proportion of female, hypertension, hyperlipidemia, peripheral arterial disease(PAD), history of PCI, angina and acute coronary syndrome(all \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), meanwhile patients in EVH group had a higher body mass index(BMI), more 3 vessel disease and left main disease. After propensity score matching, 308 pairs successfully matched with baseline SMDs\u0026thinsp;\u0026lt;\u0026thinsp;0.1 for all baseline characteristics(Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eIn-hospital outcomes\u003c/p\u003e\n\u003cp\u003eThe surgical information and postoperative in-hospital outcomes in the PSM groups are shown in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e. With the surgical information, patients in the EVH group had more numbers of vein graft (3 vs. 2, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and the OVH group had more intraoperative blood transfusion (19.5% vs. 35.3%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). There were no significant differences in operating time, CPB use and LIMA use between cohorts. EVH patients had more rates of acute kidney injury (8.5% vs. 4.2%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.045) and less prolonged mechanical ventilation (4.9% vs. 10.1%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.023). Death in hospital rates (2.3% vs. 1.3%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.543) and other in hospital postoperative outcomes (ICU stay time, low cardiac output, cardiac arrest, reoperation for bleeding and cerebral vascular accident) did not show the differences in the groups. The similar tendencies were observed between the cohorts before propensity matching (Supplementary Material, Table \u003cspan class=\"InternalRef\"\u003eS1\u003c/span\u003e.)\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eSurgical information and postoperative in hospital outcomes in propensity matched patients with open vein harvesting and endoscopic vein harvesting.\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eEVH group\u003c/p\u003e\n\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;308)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eOVH group\u003c/p\u003e\n\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;308)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eOperating time, median(IQR), min\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e260(230,300)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e265(225,300)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.635\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCardiopulmonary bypass use, n(%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e264(85.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e264(85.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.840\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCPB time, median(IQR), min\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e97(80,117)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e96(82,115)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.573\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eACC time, median(IQR), min\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e62(50,77)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e63(51,79)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.756\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eUse of LIMA, n(%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e297(96.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e297(96.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNumbers of vein graft, median(IQR), min\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3(2,3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2(3,4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIntraoperative blood transfusion, n(%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e57(19.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e108(35.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eICU time, median(IQR), day\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1(1,2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1(1,2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.119\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLow cardiac output, n(%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10(3.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12(3.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.840\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCardiac arrest, n(%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3(1.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3(1.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eReoperation for bleeding, n(%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3(1.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5(1.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.725\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eReadmitted to ICU, n(%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6(1.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8(2.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.787\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAcute kidney injury, n(%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e26(8.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13(4.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.045\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eProlonged mechanical ventilation, n(%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e15(4.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e31(10.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.023\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCerebral vascular accident, n(%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13(4.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e16(5.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.717\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDeath in hospital, n(%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7(2.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4(1.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.543\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"4\"\u003eOVH: open vein harvesting. EVH: endoscopic vein harvesting. IQR: interquartile range. CPB: cardiopulmonary bypass. ACC: aortic cross clamping. LIMA: left internal mammary artery.\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab4\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eIntraoperative transit time flow measurement between endoscopic and open vein harvesting patients in different target vessels.\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eTarget vessel\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eVariables\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eEVH group\u003c/p\u003e\n\u003cp\u003eMean(SD)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eOVH group\u003c/p\u003e\n\u003cp\u003eMean(SD)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eDifference*\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e95% CI\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eLAD systems\u003c/p\u003e\n\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;173, 133)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMGF\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e35.2 (17.99)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e34.4 (19.53)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.56\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-3.66, 4.78\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.796\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePI\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2.0 (1.08)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2.6 (3.59)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-0.57\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-1.14, -0.01\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.049\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eLCX systems\u003c/p\u003e\n\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;228, 183)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMGF\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e42.1 (26.32)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e36.6 (26.87)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e4.43\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-0.65, 9.51\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.088\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePI\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2.2 (1.22)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2.5 (1.69)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-0.27\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-0.55, 0.01\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.062\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eRCA systems\u003c/p\u003e\n\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;263, 209)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMGF\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e40.4 (24.45)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e36.4 (21.08)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3.41\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-0.75, 7.57\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.109\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePI\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2.5 (2.12)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2.3 (1.86)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.26\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-0.11, 0.62\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.170\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eTotal\u003c/p\u003e\n\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;664, 525)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMGF\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e39.6 (23.76)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e35.9 (22.89)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3.10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.45, 5.75\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.022\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePI\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2.3 (1.62)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2.4 (2.37)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-0.14\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-0.36, 0.09\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.240\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"7\"\u003e*The differences were adjusted for the diameters of corresponding target vessel. MGF: mL/min\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"7\"\u003eEVH: endoscopic vein harvesting. OVH: open vein harvesting. CI: confidence interval. MGF: mean graft flow. PI: pulsatility index.\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eTTFM results in CABG\u003c/p\u003e\n\u003cp\u003eAll patients received intraoperative TTFM during the surgery. There are totally 1189 saphenous vein grafts(SVGs) from 616 patients could be counted(664 in EVH group and 525 in OVH group). Depending on differences of the target vessels, we categorized them as LAD system(including LAD, Diagonal), LCX system(including OM) and RCA system(including RCA, PL and PDA). Most SVGs showed well fluency with the averages of MGF over 30mL/min and PI\u0026thinsp;\u0026lt;\u0026thinsp;3.0. The EVH grafts had higher MGF(39.6 mL/min vs. 35.9 mL/min, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.022) than OVH grafts with nearly the same PI(2.3 vs. 2.4, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.240). There were no significant differences in MGF between groups when categorize the SVGs with target vessels.\u003c/p\u003e\n\u003cp\u003eSurvival analysis\u003c/p\u003e\n\u003cp\u003eThere were 19 patients who had in-hospital death with 10 in EVH group. The main reason of in-hospital death was ventricular arrhythmia(42.1%, 5/10 in EVH group, 4/9 in OVH group). The median (interquartile range) follow-up time was 1.5 (1.0\u0026ndash;2.0) years in EVH cohort and 1.67 (1.0-2.25) years in OVH cohorts. Totally 28 patients were lost to follow-up (2.0%), and no significant difference was found between 2 cohorts (2.5% vs. 1.6%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.301).\u003c/p\u003e\n\u003cp\u003eThe all-cause death rate had no significant difference in different vein harvesting during the 3 years follow-up. The rate of death from all cause was 8.5% in EVH cohort vs 5.0% in OVH cohort (HR 1.565, 95%CI: 0.77\u0026ndash;3.17, Log-rank \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.21) (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003eA). After adjusting for death from non-cardiovascular causes as a competing risk, death from cardiovascular causes was 1.7% in EVH group vs 2.5% in OVH group(HR 0.769, 95%CI: 0.25\u0026ndash;2.39, Log-rank \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.65)(Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003eB).\u003c/p\u003e\n\u003cp\u003eAs the secondary outcomes, no significant differences were observed in the incidence of MACEs(8.1% vs. 7.1%, HR 1.165, 95CI: 0.51\u0026ndash;2.69, Log-rank \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.71)(Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003eC) and asymptomatic survival(66.7% vs. 72.5%, HR 1.117, 95%CI: 0.65\u0026ndash;1.92, Log-rank \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.68)(Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003eD) after adjusting death as a competing risk. The same results were observed in the original cohorts (Figure \u003cspan class=\"InternalRef\"\u003eS1\u003c/span\u003e).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this retrospective cohort study, we found that comparing with open vein harvesting, the grafts conducted by endoscopic vein harvesting showed the comparable prognosis in isolated CABG patients in 3 years follow-up with the similar morality, rates of MACEs and asymptomatic survival. As well, female, obese, diabetic and multi-vessel patients are more reasonable to use EVH when conducting CABG surgery.\u003c/p\u003e \u003cp\u003eEVH method have evolved rapidly and been widely used in the last two decades because of its smaller incisions. About 50\u0026ndash;70% patients with CABG use EVH to conducts the vein grafts in western countries\u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e. In this study, EVH was performed in 32.0% patients which had a smaller percentage comparing with some previous studies. EVH is associated with a learn curve and the saphenous vein conducted by inexperienced surgeons could cause the early graft failure\u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e. In this research, the EVH procedure was conducted by an experienced surgeon(Professor Shao.) to decrease the bias caused by the surgery.\u003c/p\u003e \u003cp\u003eTwo subgroup analysis of the clinical trials(PREVENT IV Trial and ROOBY Trial) suggested that EVH was associated with higher rates of vein graft failure and repeat revascularization\u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e. However, these two RCTs were conducted 10 years ago and were not designed to compare the outcomes of EVH and OVH technique. REGROUP Trial\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e was the first randomized trial to describe the outcomes between EVH and OVH in western countries. In our study, we compare the early and mid-term prognosis of EVH grafts which showed that there were no significant differences in the rates of all-cause death and MACEs in 3 years after the CABG surgery comparing with OVH groups. This is consistent with the results of several recent retrospective studies\u003csup\u003e[\u003cspan additionalcitationids=\"CR19\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e and REGROUP Trial.\u003c/p\u003e \u003cp\u003eCurrently, TTFM was more confirmed the association with graft patency and postoperative clinical outcomes\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e. Early graft failure occurred predominantly in SVGs with lower MGF and higher PI\u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e. In this study, most vein grafts measured by TTFM during the surgery. The MGF of all vein graft counted were over 31 ml/min, which was considered as a risk factor of early graft failure\u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e. Meanwhile, we found that EVH grafts showed a higher MGF than OVH grafts and the PI between cohorts had no significant differences which suggested that appropriately stretching SV in EVH technique may not have the immediate effect on MGF in the surgery. This could also explain that similar prognosis in the early and mid-term follow-up.\u003c/p\u003e \u003cp\u003eThere are still several limitations of this research. Firstly, this study was a single-center retrospective cohort study, some potential biases could not be fully avoided and a multicenter randomized controlled study could be more convincing. Secondly, EVH procedures were conducted by the same experience surgeon, however, the OVH were performed by different surgeons in our center, which could affect the efficiency of treatment in OVH group.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn this cohort study from East China, EVH shows a similar in-hospital outcomes comparing with OVH. Also, in the 3 years follow-up, EVH is not associated with worse clinic outcomes(all-cause death, MACEs) to OVH. Longer follow-up need to be conducted further to evaluate the long-term prognosis of EVH additionally.\u003c/p\u003e"},{"header":"Abbreviations and Acronyms ","content":"\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.252252252252251%\" valign=\"top\"\u003e\n \u003cp\u003eCABG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.504504504504505%\" valign=\"top\"\u003e\n \u003cp\u003e=\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"83.24324324324324%\" valign=\"top\"\u003e\n \u003cp\u003ecoronary artery bypass graft\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.252252252252251%\" valign=\"top\"\u003e\n \u003cp\u003eEVH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.504504504504505%\" valign=\"top\"\u003e\n \u003cp\u003e=\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"83.24324324324324%\" valign=\"top\"\u003e\n \u003cp\u003eendoscopic vein harvesting\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.252252252252251%\" valign=\"top\"\u003e\n \u003cp\u003eLIMA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.504504504504505%\" valign=\"top\"\u003e\n \u003cp\u003e=\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"83.24324324324324%\" valign=\"top\"\u003e\n \u003cp\u003eleft internal mammary artery\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.252252252252251%\" valign=\"top\"\u003e\n \u003cp\u003eMACEs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.504504504504505%\" valign=\"top\"\u003e\n \u003cp\u003e=\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"83.24324324324324%\" valign=\"top\"\u003e\n \u003cp\u003emajor adverse cardiovascular events\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.252252252252251%\" valign=\"top\"\u003e\n \u003cp\u003eOVH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.504504504504505%\" valign=\"top\"\u003e\n \u003cp\u003e=\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"83.24324324324324%\" valign=\"top\"\u003e\n \u003cp\u003eopen vein harvesting\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.252252252252251%\" valign=\"top\"\u003e\n \u003cp\u003eTTFM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.504504504504505%\" valign=\"top\"\u003e\n \u003cp\u003e=\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"83.24324324324324%\" valign=\"top\"\u003e\n \u003cp\u003etransit time flow measurement\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003eAcknowledges\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003eAuthors\u0026rsquo; contributions\u003c/p\u003e\n\u003cp\u003eW.W and H.Q wrote the main manuscript text, Yi.L ,Ya.L and Y.J contributed to the data curation.Yi.L J.S and W.C contributed to the methodology. W.W and R.F did the formal analysis. C.S and X.C contributed to the project administration. All authors reviewed the whole manuscript.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eNo funding.\u003c/p\u003e\n\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eThe study was approved by the ethics committee of Nanjing First Hospital(Nanjing, Jiangsu, Republic of China.)for the data collection (KY20170811-03) and individual consent for this retrospective analysis was waived.\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eWritten consent for publication was obtained from patients.\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003eConflict of interest and Sources of funding:\u003c/p\u003e\n\u003cp\u003enone.\u003c/p\u003e\n\u003cp\u003eData Availability Statement:\u003c/p\u003e\n\u003cp\u003eAll relevant data are within the manuscript and the supplementary material.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eLawton J S, Tamis-Holland J E, Bangalore S, et al. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines[J]. Circulation,2022,145(3):e4-e17.\u003c/li\u003e\n\u003cli\u003eLi X, Gu D, Wang X, et al. Trends of Coronary Artery Bypass Grafting Performance in a Cohort of Hospitals in China Between 2013 and 2018[J]. Circ Cardiovasc Qual Outcomes,2021,14(4):e7025.\u003c/li\u003e\n\u003cli\u003eAthanasiou T, Aziz O, Skapinakis P, et al. Leg wound infection after coronary artery bypass grafting: a meta-analysis comparing minimally invasive versus conventional vein harvesting[J]. Ann Thorac Surg,2003,76(6):2141-2146.\u003c/li\u003e\n\u003cli\u003eMarkar S R, Kutty R, Edmonds L, et al. A meta-analysis of minimally invasive versus traditional open vein harvest technique for coronary artery bypass graft surgery[J]. Interact Cardiovasc Thorac Surg,2010,10(2):266-270.\u003c/li\u003e\n\u003cli\u003eFerdinand F D, Macdonald J K, Balkhy H H, et al. Endoscopic Conduit Harvest in Coronary Artery Bypass Grafting Surgery: An ISMICS Systematic Review and Consensus Conference Statements[J]. Innovations (Phila),2017,12(5):301-319.\u003c/li\u003e\n\u003cli\u003eNeumann F J, Sousa-Uva M, Ahlsson A, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization[J]. Eur Heart J,2019,40(2):87-165.\u003c/li\u003e\n\u003cli\u003eFerdinand F D, Macdonald J K, Balkhy H H, et al. Endoscopic Conduit Harvest in Coronary Artery Bypass Grafting Surgery: An ISMICS Systematic Review and Consensus Conference Statements[J]. Innovations (Phila),2017,12(5):301-319.\u003c/li\u003e\n\u003cli\u003eZenati M A, Bhatt D L, Bakaeen F G, et al. Randomized Trial of Endoscopic or Open Vein-Graft Harvesting for Coronary-Artery Bypass[J]. N Engl J Med,2019,380(2):132-141.\u003c/li\u003e\n\u003cli\u003eRousou L J, Taylor K B, Lu X G, et al. Saphenous vein conduits harvested by endoscopic technique exhibit structural and functional damage[J]. Ann Thorac Surg,2009,87(1):62-70.\u003c/li\u003e\n\u003cli\u003eGaudino M, Sandner S, Di Giammarco G, et al. The Use of Intraoperative Transit Time Flow Measurement for Coronary Artery Bypass Surgery: Systematic Review of the Evidence and Expert Opinion Statements[J]. Circulation,2021,144(14):1160-1171.\u003c/li\u003e\n\u003cli\u003eDeb S, Austin P C, Tu J V, et al. A Review of Propensity-Score Methods and Their Use in Cardiovascular Research[J]. Can J Cardiol,2016,32(2):259-265.\u003c/li\u003e\n\u003cli\u003eSilber J H, Rosenbaum P R, Trudeau M E, et al. Multivariate matching and bias reduction in the surgical outcomes study[J]. Med Care,2001,39(10):1048-1064.\u003c/li\u003e\n\u003cli\u003eOuzounian M, Hassan A, Buth K J, et al. Impact of endoscopic versus open saphenous vein harvest techniques on outcomes after coronary artery bypass grafting[J]. Ann Thorac Surg,2010,89(2):403-408.\u003c/li\u003e\n\u003cli\u003eLopes R D, Hafley G E, Allen K B, et al. Endoscopic versus open vein-graft harvesting in coronary-artery bypass surgery[J]. N Engl J Med,2009,361(3):235-244.\u003c/li\u003e\n\u003cli\u003eDesai P, Kiani S, Thiruvanthan N, et al. Impact of the learning curve for endoscopic vein harvest on conduit quality and early graft patency[J]. Ann Thorac Surg,2011,91(5):1385-1391, 1391-1392.\u003c/li\u003e\n\u003cli\u003eMagee M J, Alexander J H, Hafley G, et al. Coronary artery bypass graft failure after on-pump and off-pump coronary artery bypass: findings from PREVENT IV[J]. Ann Thorac Surg,2008,85(2):494-499, 499-500.\u003c/li\u003e\n\u003cli\u003eZenati M A, Shroyer A L, Collins J F, et al. 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[J]. J Thorac Cardiovasc Surg,2011,141(2):338-344.\u003c/li\u003e\n\u003cli\u003eDacey L J, Braxton J J, Kramer R S, et al. Long-term outcomes of endoscopic vein harvesting after coronary artery bypass grafting[J]. Circulation,2011,123(2):147-153.\u003c/li\u003e\n\u003cli\u003eWilliams J B, Peterson E D, Brennan J M, et al. Association between endoscopic vs open vein-graft harvesting and mortality, wound complications, and cardiovascular events in patients undergoing CABG surgery[J]. JAMA,2012,308(5):475-484.\u003c/li\u003e\n\u003cli\u003eHarskamp R E, Lopes R D, Baisden C E, et al. Saphenous vein graft failure after coronary artery bypass surgery: pathophysiology, management, and future directions[J]. Ann Surg,2013,257(5):824-833.\u003c/li\u003e\n\u003cli\u003eTokuda Y, Song M H, Oshima H, et al. Predicting midterm coronary artery bypass graft failure by intraoperative transit time flow measurement[J]. Ann Thorac Surg,2008,86(2):532-536.\u003c/li\u003e\n\u003cli\u003eZientara A, Rings L, Bruijnen H, et al. Early silent graft failure in off-pump coronary artery bypass grafting: a computed tomography analysisdagger[J]. Eur J Cardiothorac Surg,2019,56(5):919-925.\u003c/li\u003e\n\u003cli\u003eUne D, Deb S, Chikazawa G, et al. Cut-off values for transit time flowmetry: are the revision criteria appropriate?[J]. J Card Surg,2013,28(1):3-7.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-cardiothoracic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jcts","sideBox":"Learn more about [Journal of Cardiothoracic Surgery](http://cardiothoracicsurgery.biomedcentral.com)","snPcode":"13019","submissionUrl":"https://submission.nature.com/new-submission/13019/3","title":"Journal of Cardiothoracic Surgery","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Endoscopic vein harvesting, Open vein harvesting, coronary artery bypass grafting, Prognosis","lastPublishedDoi":"10.21203/rs.3.rs-4181365/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4181365/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eOBJECTIVES\u003c/h2\u003e \u003cp\u003eEndoscopic vein harvesting (EVH) is an alternative technique to obtain the saphenous vein for coronary artery bypass graft (CABG) surgery. We aimed to evaluate the early and mid-term outcomes of patients with EVH in CABG.\u003c/p\u003e\u003ch2\u003eMETHODS\u003c/h2\u003e \u003cp\u003eThis cohort study included consecutive isolated CABG patients in Nanjing First Hospital from July 2020 to December 2022 using propensity score matching methods. Patients were classified to EVH group and open vein harvesting (OVH) group according to the vein harvesting methods. The primary outcome was the all-cause death, and the secondary outcomes were major adverse cardiovascular events (MACEs) including cardiovascular death, heart failure, myocardial infarction and revascularization and asymptomatic survival in the follow-up.\u003c/p\u003e\u003ch2\u003eRESULTS\u003c/h2\u003e \u003cp\u003eTotally 1247 patients were included in the study with 849 in OVH group and 398 in EVH group. Patients with EVH were more female, diabetes, higher body mass index, more multi-vessel and left main diseases. 308 pairs were formed after the matching. There was no significant difference in the rates of in-hospital death (EVH vs. OVH, 2.3% vs. 1.3%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.543). During the 3 years follow-up, EVH grafts were considered not inferior to OVH grafts, no differences were found in all-cause death [8.5% vs. 5.0%, hazard ratio (HR) 1.565, 95% confidence interval (CI): 0.77\u0026ndash;3.17, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.21], MACEs (8.1% vs. 7.1%, HR 1.165, 95CI: 0.51\u0026ndash;2.69, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.71) and asymptomatic survival (66.7% vs. 72.5%, HR 1.117, 95%CI: 0.65\u0026ndash;1.92, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.68).\u003c/p\u003e\u003ch2\u003eCONCLUSIONS\u003c/h2\u003e \u003cp\u003eEVH grafts were considered comparable to OVH grafts in patients following CABG in the 3 years follow-up.\u003c/p\u003e","manuscriptTitle":"Mid-term outcomes of endoscopic vein harvesting in coronary artery bypass graft: A retrospective cohort study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-08 19:10:12","doi":"10.21203/rs.3.rs-4181365/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-05-25T12:37:42+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-05-18T16:29:56+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-05-18T02:18:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"143467079927342333683751898904303165010","date":"2024-05-08T09:01:54+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-05-07T20:34:14+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-05-04T08:53:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"201961633443823286881117637489182703191","date":"2024-05-03T21:31:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"319882701602314174609594079104814234331","date":"2024-05-01T15:37:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"222730426345177666924992266505351082478","date":"2024-05-01T14:48:29+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-05-01T13:58:43+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-04-03T01:04:33+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-04-03T01:04:33+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Cardiothoracic Surgery","date":"2024-03-28T10:04:25+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-cardiothoracic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jcts","sideBox":"Learn more about [Journal of Cardiothoracic Surgery](http://cardiothoracicsurgery.biomedcentral.com)","snPcode":"13019","submissionUrl":"https://submission.nature.com/new-submission/13019/3","title":"Journal of Cardiothoracic Surgery","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3359cd1b-f5df-4f35-8793-1874ae5aff9a","owner":[],"postedDate":"April 8th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2024-06-15T16:47:51+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-08 19:10:12","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4181365","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4181365","identity":"rs-4181365","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}