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Endoscopic versus open radial artery harvesting for coronary artery bypass grafting
1Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH 44195, USA. naviaj@ccf.org
Insights
Endoscopic radial artery harvesting for coronary artery bypass grafting (CABG) offers superior wound healing and reduced pain compared to open harvesting. Both methods show infrequent complications, with endoscopic procedures demonstrating better wound appearance.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Minimally Invasive Surgery
Background:
- The radial artery is a preferred conduit for coronary artery bypass grafting (CABG) after the internal thoracic artery.
- Comparing harvesting techniques is crucial for optimizing patient outcomes.
Purpose of the Study:
- To compare wound healing and arm complications between endoscopic and open radial artery harvesting for CABG.
- To evaluate the safety and efficacy of endoscopic versus conventional open radial artery harvesting.
Main Methods:
- A retrospective study of 509 patients undergoing CABG with radial artery conduits from January 2002 to July 2004.
- Propensity score matching was used to compare 39 endoscopic harvesting patients with 117 open harvesting patients.
- Outcomes assessed included wound healing (Hollander scale), neurologic deficits, wound infection, and pain scores.
Main Results:
- Endoscopic harvesting resulted in significantly better wound healing (Hollander score) and wound appearance compared to open harvesting (P=0.01 and P=0.004, respectively).
- Pain scores were lower with endoscopic harvesting (P=0.006).
- Neurologic deficits and wound infection rates were infrequent and similar between groups, though infections were more severe with open harvesting.
Conclusions:
- Endoscopic radial artery harvesting is associated with improved wound appearance and reduced postoperative pain compared to conventional open harvesting.
- Both methods are safe and effective, with low rates of complications such as neurologic deficits and wound infections.
Aim:
The radial artery has become the artery of choice after the internal thoracic artery for coronary artery bypass grafting (CABG). This study compares wound healing and arm complications after endoscopic versus open radial artery harvesting for CABG.
Methods:
From January 2002 to July 2004, 509 patients underwent CABG in which a radial artery conduit was used. Thirty-nine had endoscopic and 470 had conventional open radial artery harvesting. A propensity score was used to obtain 1:3 matching of all endoscopic to 117 open-harvesting patients. Postoperative wound healing using the Hollander scale, local neurologic deficits, wound infection, and pain scores were compared.
Results:
Wound healing: 34 of 39 endoscopic wounds exhibited a perfect Hollander score versus 339 of 470 open-harvest wounds (P=0.01). Wound appearance in particular was better than for open harvesting (P=0.004), with no abnormal step-off borders, irregular contours, or abnormal scar width observed. Neurologic deficits. Three incomplete neurologic deficits were observed after open harvesting (two being distal sensitivity localized in the interspace between the first and second metacarpals); one complete neurologic deficit occurred after endoscopic harvesting, but improved remarkably prior to hospital discharge. Wound infection. Occurrence of wound infection was similar in the two groups (P=0.7), although infection was more severe with open harvesting. Pain: pain score was lower (P=0.006) with endoscopic harvesting.
Conclusion:
Compared with conventional open harvesting, endoscopic radial artery harvesting was associated with better wound appearance and less pain. Occurrence of neurologic deficits and wound infection was infrequent in both groups.
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