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Vein Removal Method Linked to Bypass Results

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"The dominos appear to be in a straight line, but we don't know if they are supposed to be that way or just appear to be that way."

There is no obvious solution to the conundrum, he said. "It is incumbent on the cardiac surgical community to determine how to impact the risk-benefit equation so that we eliminate the downside while making the upside even better," Ferguson said.

"Every cardiac surgical group in the country should pay particular attention to the vein harvesting procedure," he said. "We must evaluate these things on an individual patient basis."

Ultimate answers would come only from a large controlled trial with long-term follow-up, comparing results of bypass procedures done with veins removed by the two different methods, Alexander and Ferguson said.

Such a trial would be difficult to do and might raise ethical questions, Ferguson said. "And it would be years before we had results," Alexander added.

The reason for the difference in outcomes is unclear, he said. "The best hypothesis is that some damage is done to the vein in endoscopic harvesting," Alexander said. "What it is and how you might change it are unknown."