Endoscopic Radial Artery Harvest for Coronary Artery Bypass Grafting: Initial Clinical Experience
DOI:
https://doi.org/10.1532/HSF98.20041049Abstract
Background: Recently, an endoscopic technique was developed to harvest the radial artery (RA) via a 3-cm wrist incision in patients undergoing coronary artery bypass graft (CABG). The aim of this study was to evaluate our initial clinical experience with this technology.
Methods: Data were prospectively collected on 75 consecutive patients undergoing CABG with endoscopic RA harvest using the Ultra-Retractor (CardioVations, Somerville, NJ, USA) and the harmonic scalpel (Ethicon Endo-Surgery, Cincinnati, OH, USA).
Results: There were 66 men (88%) and 9 women (12%) with a mean age of 60 years (range, 31-77 years). Forty-eight (64%) of cases had non-elective surgery. Thirty-one (41%) of patients had diabetes. Sixty seven percent of the operations were performed on pump and 33% off pump. Average RA harvest time was 66 minutes (range, 25-120 minutes) with a significant learning curve (75 minutes for the first 20 cases and 63 minutes for the last 50 cases). Two (2.6 %) radial arteries were discarded, one because of extensive calcifications and the other because of damage to the conduit. No patients suffered death, perioperative myocardial infarction, or stroke. There was one reexploration of the forearm for a tunnel hematoma. Follow-up was achieved in 100% of patients and averaged 3.6 months (range, 0.5-13 months). Two patients died during the follow-up. There were no myocardial infarctions or reinterventions, with 96% of patients in functional class I /II. There were no motor deficits. There were no sensory deficits in the distribution of the lateral antebrachial cutaneous nerve, but transient mild dorsal thenar numbness or paresthesias were observed in 86% of patients. Cosmetic results were defined as good to excellent in 82% of patients. Conclusions: Short-term results of endoscopic RA harvest are excellent. There is a significant learning curve. Long-term follow-up as well as structural and functional assessments of the conduit are indicated.
References
Acar C, Ramsheyi A, Pagny JY, et al. 1998. The radial artery for coronary artery bypass grafting: clinical and angiographic results at five years. J Thorac Cardiovasc Surg 116:981-9.nRoyse AG, Royse CF, Shah P, Williams A, Kaushik S, Tatoulis J. 1999. Radial artery harvest technique, use and functional outcome. Eur J Cardiothorac Surg 15:186-93.nSaeed I, Anyuanwu AC, Yacoub MH, Amrani M. 2001. Subjective patient outcomes following coronary artery bypass using the radial artery: results of the harvest site complications and quality of life. Eur J Cardiothorac Surg 20:1141-6.nShapira OM, Alkon JD, Aldea GS, Madera F, Lazar HL, Shemin RJ. 1997. Clinical outcomes in patients undergoing coronary artery bypass grafting with preferred use of the radial artery. J Cardiac Surg 12:381-8.nShapira OM, Xu A, Vita JA, et al. 1999. Nitroglycerin is superior to diltiazem as a coronary bypass conduit vasodilator. J Thorac Cardiovasc Surg 117:906-11.nSociety of Thoracic Surgeons (STS). 2003. STS National Adult Cardiac Surgery Database. Data analysis of the Society of Thoracic Surgeons National Adult Cardiac Surgery Database: the 13th year. Durham, NC: Duke Clinical Research Institute.nTatoulis J, Buxton BF, Fuller JA. 1998. Bilateral radial artery grafts in coronary reconstruction: technique and early results in 261 patients. Ann Thorac Surg 66:714-20.nTatoulis J, Royse AG, Buxton BF, et al. 2002. The radial artery in coronary surgery: a 5-year experience-clinical and angiographic results. Ann Thorac Surg 73:143-8.nFisk RL, Brooks CH, Callaghan JC, Dvorkin J. 1976. Experiences with the radial artery graft for coronary artery bypass. Ann Thorac Surg 21:513-8.nGenovesi MH, Torrillo L, Fonger J, Patel N, McCabe JC, Subramanian VA. 2001. Endoscopic radial artery harvest: a new approach. Heart Surg Forum 4:223-4.nHambley R, Hebda PA, Abell E, Cohen BA, Jegasothy BV. 1988. Wound healing of skin incisions produced by ultrasonically vibrating knife, scalpel, electrocautery, and carbon dioxide laser. J Dermatol Surg Oncol 14:1213-7.nMeharwal ZS, Trehan N. 2001. Functional status of the hand after radial artery harvesting: results in 3,977 cases. Ann Thorac Surg 72:1557-61.nPosacioglu H, Atay Y, Çetindag B, Saribülbül O, Buket S, Hamulu A. 1998. Easy harvesting of radial artery with ultrasonically activated scalpel. Ann Thoracic Surg 65:985-5.nReyes AT, Frame R, Brodman RF. 1995. Technique for harvesting the radial artery as a coronary artery bypass graft. Ann Thorac Surg 59:118-26.nRonan JW, Perry LA, Barner HB, Sundt TM. 2000. Radial artery harvest: comparison of ultrasonic dissection with standard technique. Ann Thorac Surg 69113-4.nAmaral JF. 1994. Ultrasonic dissection. Endosc Surg Allied Technol 2:181-5.nCaputo, M, Reeves B, Marchetto G, Mahesh B, Lim K, Angelini GD. 2003. Radial artery versus right internal thoracic artery as a second arterial conduit for coronary surgery: early and midterm outcomes. J Thorac Cardiovasc Surg 126:39-47.nCarpentier A, Guermonprez JL, Deolche A, et al. 1973. The aorta-to-coronary radial artery bypass graft. A technique avoiding pathological changes in the grafts. Ann Thorac Surg 16:111-121.nCikirkcioglu M, Yasa M, Kerry Z, Posacioglu H, Boga M, Yagdi T. 2001. The effects of the harmonic scalpel on the vasoreactivity and endothelial integrity of the radial artery. A comparison of two techniques. J Thorac Cardiovasc Surg 122:624-4.nConnolly MW, Torrillo LD, Stauder MJ, et al. 2002. Endoscopic radial artery harvesting: results of first 300 patients. Ann Thorac Surg 74:502-6.nCurtis JJ, Stoney WS, Alford WC, Burrus GR, Thomas CS. Intimal hyperplasia: 1975. A cause of radial artery aorto-coronary bypass graft failure. Ann Thorac Surg 20:628-35.nDenton TA, Trento L, Cohen M, Kass RM, Blanche C, Raissi S. 2001. Radial artery harvesting for coronary artery bypass operations: neurologic complications and their potential mechanism. J Thorac Cardiovasc Surg 121:951-6.nWright CB, Barner HB, Gao A, et al. 2001. The advantages of the harmonic scalpel for harvesting the radial artery for coronary artery bypass. Heart Surg Forum 4:226-30.n
