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NCT Number: NCT01850082

Randomized Endo-Vein Graft Prospective

Coronary artery bypass grafting (CABG) is the most common major surgical procedure in the United States with over 300,000 cases performed each year. To restore blood flow to the heart, vascular conduits from another part of the body are procured to create a bypass around critically blocked coronary arteries. The left internal thoracic artery is the conduit of choice for CABG due to its superior long-term patency. However, almost all patients referred for CABG require additional grafts to provide complete revascularization. This necessitates the harvest of other vessels, most commonly the saphenous vein which is used almost ubiquitously in contemporary CABG with an average of two vein grafts per CABG procedure. In the last 10 years, Endoscopic Vein Harvesting (EVH) has been recommended as the preferred method over the traditional open harvesting technique (OVH) because it provides a minimally invasive approach. However, more recent investigations indicate potential for reduced long-term bypass graft patency and worse clinical outcomes with EVH. The long term impact of EVH on clinical outcomes has never been investigated on a large scale using a definitive, adequately powered, prospective Randomized Controlled Trial (RCT) with long-term follow-up.

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Key information

Conditions

Coronary Artery Bypass Grafting Arterial Occlusive Diseases Arteriosclerosis Cardiovascular Diseases Coronary Artery Disease Coronary Disease Heart Diseases Myocardial Ischemia Vascular Diseases

Age range

18 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Southern Arizona VA Health Care System, Tucson, AZ, Tucson, Arizona, United States

Loading trial locations.

About this study

CSP #588 - REGROUP is a randomized, intent-to-treat, two-arm, parallel design, multicenter study. Cardiac Surgery Programs at Veterans Affairs Medical Centers (VAMC) with expertise in performing both EVH and OVH will be invited to participate in the study. Subjects requiring elective or urgent CABG using cardiopulmonary bypass with use of at least one SVG will be screened for enrollment using established inclusion/exclusion criteria. Enrolled Subjects will be randomized to one of the two arms (EVH or OVH) after an experienced vein harvester is identified and assigned. Intraoperative assessments will be collected and post-operative assessments will be completed 24 hours post-surgery. Additional assessments will be completed at the time of discharge or at the 30-day post-surgery date if the subject is still in the hospital. Assessment of leg wound complications will be completed at the time of discharge and at six-week post-surgery. Telephone follow-ups will occur at three-month interval post-surgery until the participating sites are decommissioned at the end of the trial period (which would be approximately 4.5 years after the site initiations). For long-term MACE outcomes, passive follow up for MACE events using VA databases (CPRS, VASQIP) will be performed centrally by the Study Chair's office for another 2 years.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Age years 18 years or older
  • Elective or Urgent CABG-only
  • Median sternotomy approach
  • At least one coronary bypass planned using saphenous vein graft for conduit
  • Experienced EVH/OVH harvester available for procedure

Exclusion criteria

  • Combined valve procedure planned
  • Moderate or severe valve disease (see definition of moderate/severe valve)
  • Hemodynamically unstable or in cardiogenic shock
  • Enrolled in another therapeutic or interventional study
  • Off-pump CABG procedure planned
  • Limited life expectancy < 1 year
  • History of lower extremities venous stripping or ligation
  • Inability to provide informed consent

Treatment and study plan

Vein Harvesting Procedures

Procedure

Open Vein Harvesting is the traditional method of saphenectomy for CABG. It is performed under direct vision using a single long incision or, more commonly, multiple smaller incisions (referred to as "bridging" technique) along the course of the vein. This approach minimizes manipulation and direct trauma to the conduit but is associated with potential for discomfort and leg wound healing complications. Endoscopic Vein Harvesting is a minimally invasive procedure that was developed to eliminate the need for long incisions associated with OVH. EVH reduces the risk of wound infections and other leg wound complications but may be more traumatic to the conduit than OVH.

Primary outcomes

  1. Incidence of First MACE During Active Follow-up Period.

    Time frame: Varying timeframe for each participant with a minimum of 1 year and a maximum 4.5 Years

    Incidence of first MACE estimated via Kaplan Meier survival analysis (MACE defined as death from any cause, repeat revascularization, myocardial infarction) during the active follow-up period.

Secondary outcomes

  1. MACE at One Year.

    Time frame: 1 year

    Proportion of patients with MACE (death from any cause, repeat revascularization, myocardial infarction) at one year postoperatively.

  2. MACE at Three Years.

    Time frame: 3 years

    Proportion of patients with MACE (death from any cause, repeat revascularization, myocardial infarction) at three years postoperatively.

  3. Incidence of First MACE Over the Entire Follow-up Period (Active and Passive).

    Time frame: Varying timeframe for each participant with a minimum of 3 years and a maximum of 6.5 years

    Incidence of first MACE estimated via Kaplan Meier survival analysis (MACE defined as death from any cause, repeat revascularization, myocardial infarction) during the entire follow-up period (active and passive).

Sponsors and collaborators

Lead sponsor

VA Office of Research and Development

Fed

Registry information

Official study title

CSP #588 - Randomized Endo-Vein Graft Prospective (REGROUP) Trial

Acronym: REGROUP

Important dates

Study start
2013
Primary completion
2020
Study completion
2020
First posted
May 9, 2013
Registry last updated
Dec 15, 2021

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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