Endoscopic Radial Artery Harvesting for Coronary Artery Bypass Grafting: The Initial Clinical Experience and Results of the First 50 Patients
DOI:
https://doi.org/10.1532/HSF98.20091080Abstract
Background: The radial artery (RA) is a commonly used arterial conduit in coronary artery bypass grafting (CABG). Traditional open-vessel harvest often leads to postoperative wound complications and cosmetic problems. Endoscopic RA harvesting (ERAH) has been widely used to prevent these problems. The purpose of this study was to assess these problems and graft patency in the first 50 patients who underwent ERAH.
Methods: Between February 2006 and October 2007, 50 patients underwent ERAH with the VasoView system (Boston Scientific). These patients were compared with 50 patients who underwent the traditional open technique.
Results: The mean age was 62.8 years in both groups. All RAs were successfully harvested. No conversion was made from ERAH to the traditional open technique. The mean harvesting time (forearm ischemic time) was 27.4 ± 6.5 minutes, and the mean length of the RA in the ERAH group was 18.5 cm. Neither wound complications, such as wound infection and skin necrosis, nor severe neurologic complications were recorded. The patency rate was 95.9% (95/99) in the ERAH group and 94% (94/100) in the open group.
Conclusion: ERAH can be performed safely, and the early results are satisfactory. Endoscopic vessel harvesting is therefore recommended as the technique of choice for RA harvesting.
References
Acar C, Jebara V, Portoghese M, et al. 1992. Revival of the radial artery for coronary artery bypass grafting. Ann Thorac Surg 54:652-9.nAllen KB, Griffith GL, Heimansohn DA, et al. 1998. Endoscopic versus traditional saphenous vein harvesting: a prospective, randomized trial. Ann Thorac Surg 66:26-31.nBorger M, Rao V, Weisel R, et al. 1998. Deep sternal wound infection: risk factors and outcomes. Ann Thorac Surg 65:1050-6.nBuxton BF, Komeda M, Fuller JA, Gordon I. 1998. Bilateral internal thoracic artery grafting may improve outcome of coronary artery surgery: risk-adjusted survival. Circulation 98:1-6.nCameron A, Davis KB, Green G, Schaff HV. 1996. Coronary bypass surgery with internal-thoracic-artery grafts—effects on survival over a 15-year period. N Engl J Med 334:216-9.nCarpentier A, Geha AS, Krone RJ, McCormick JR, Baue AE. 1975. Discussion of selection of coronary bypass: anatomic, physiological and angiographic considerations of vein and mammary artery grafts. J Thorac Cardiovasc Surg 70:429-30.nCarpentier A, Guermonprez J, Deloche A, Frechette C, DuBost C. 1973. The aorta-to-coronary radial artery bypass graft. A technique avoiding pathological changes in grafts. Ann Thorac Surg 16:111-21.nCrouch JD, O'Hair DP, Keuler JP, Barragry TP, Werner PH, Kleinman LH. 1999. Open versus endoscopic saphenous vein harvesting: wound complications and vein quality. Ann Thorac Surg 68:1513-6.nIto N, Tashiro T, Morishige N, et al. 2008. The long-term results of coronary artery bypass grafting with radial artery graft. J Jpn Coron Assoc 14:211-6.nKnobloch K, Lichtenberg A, Tomaszek S, et al. 2005. Long-term physical activity and neurologic function after harvesting of the radial artery as T-graft or free graft in coronary revascularization. Ann Thorac Surg 80:918-21.nLoop FD, Lytle BW, Cosgrove DM, et al. 1986. Influence of the internal-mammary-artery graft on 10-year survival and other cardiac events. N Engl J Med 314:1-6.nLytle BW, Blackstone EH, Loop FD, et al. 1999. Two internal thoracic artery grafts are better than one. J Thorac Cardiovasc Surg 117:855-72.nMoon MR, Barner HB, Bailey MS, et al. 2004. Long-term neurologic hand complications after radial artery harvesting using conventional cold and harmonic scalpel techniques. Ann Thorac Surg 78:535-8.nParisian Mediastinitis Study Group. 1996. Risk factors for deep sternal wound infection after sternotomy: a prospective, multicenter study. J Thorac Cardiovasc Surg 111:1200-7.nPatel AN, Henry AC, Hunnicutt C, Cockerham CA, Willey B, Urschel HC Jr. 2004. Endoscopic radial artery harvesting is better than the open technique. Ann Thorac Surg 78:149-53.nPossati G, Gaudino M, Prati F, et al. 2003. Long-term results of the radial artery used for myocardial revascularization. Circulation 108:1350-4.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.nRoyse AG, Royse CF, Tatoulis J, et al. 2000. Postoperative radial artery angiography for coronary artery bypass surgery. Eur J Cardiothorac Surg 17:294-304.nRudez I, Unic D, Sutlic Z, et al. 2007. Endoscopic radial artery harvesting reduces postoperative pain and neurologic complications. Heart Surg Forum 10:E363-5.nSaeed I, Anyanwu AC, Yacoub MH, Amrani M. 2001. Subjective patient outcomes following coronary artery bypass using the radial artery: results of a cross-sectional survey of harvest site complications and quality of life. Eur J Cardiothorac Surg 20:1142-6.nShapira OM, Eskenazi BR, Anter E, et al. 2006. Endoscopic versus conventional radial artery harvest for coronary artery bypass grafting: functional and histologic assessment of the conduit. J Thorac Cardiovasc Surg 131:388-94.nSiminelakis S, Karfis E, Anagnostopoulos C, Toumpoulis I, Katsaraki A, Drossos G. 2004. Harvesting radial artery and neurologic complications. J Card Surg 19:505-10.nTaggart DP, D'Amico R, Altman DG. 2001. Effect of arterial revascularization on survival: a systematic review of studies comparing bilateral and single internal mammary arteries. Lancet 358:870-5.nTashiro T, Nakamura K, Iwakuma A, et al. 1999. Inverted T graft: novel technique using composite radial and internal thoracic arteries. Ann Thorac Surg 67:629-31.nTatoulis J, Buxton BF, Fuller JA. 2004. Patencies of 2127 arterial to coronary conduits over 15 years. Ann Thorac Surg 77:93-101.n
