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Published on: April 1, 2022
Results of endoscopic radial artery harvesting in 1577 patients
Kamellia R Dimitrova1, Gabriela R Dincheva, Darryl M Hoffman
1From the Division of Cardiothoracic Surgery, Beth Israel Medical Center, New York, NY USA.
Insights
Endoscopic radial artery (RA) harvesting for coronary artery bypass grafting (CABG) shows excellent results. This minimally invasive technique offers low mortality and good long-term patency, making it a valuable option for cardiac surgery.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Techniques
- Vascular Grafting
Background:
- Coronary artery bypass grafting (CABG) is a common procedure for treating coronary artery disease.
- Radial artery (RA) is increasingly used as a conduit in CABG.
- Minimally invasive harvesting techniques aim to reduce surgical morbidity.
Purpose of the Study:
- To evaluate the outcomes of endoscopic radial artery harvesting in a large cohort of CABG patients.
- To assess the safety, efficacy, and long-term patency of endoscopically harvested RA grafts.
Main Methods:
- A prospective review of 1577 consecutive patients undergoing CABG with endoscopic RA harvest.
- Data collection included patient demographics, procedural details, and mortality.
- Kaplan-Meier survival and graft patency were analyzed.
Main Results:
- Operative mortality was low at 0.57%, with 0.34% in isolated CABG and 3.85% in combined procedures.
- Ten-year survival was estimated at 88%, with overall RA graft patency at 82%.
- Postoperative complications included a 0.32% incisional infection rate; no ischemic hand complications were reported.
Conclusions:
- Endoscopic RA harvesting is a safe and effective minimally invasive technique for CABG.
- It offers excellent long-term graft patency and survival with minimal morbidity.
- This approach represents a valuable conduit harvesting strategy in cardiac surgery.
Objective:
We reviewed 1577 consecutive patients undergoing coronary artery bypass grafting (CABG) using endoscopic harvesting of the radial artery (RA) to define our current results.
Methods:
Since 2000, we have performed endoscopic RA harvest on 1577 consecutive patients; 1476 patients had isolated CABG, and 101 patients had CABG and other procedures. The mean ± SD age was 59.4 ± 9.0 years; 80.2% were men and 40% had diabetes mellitus. All data were prospectively collected. All-cause mortality was determined using the Social Security Death Index.
Results:
There were nine in-hospital or 30-day deaths, for an operative mortality of 0.57%: mortality was 0.34% in isolated CABG and 3.85% in CABG/combined procedures. The overall estimated Kaplan-Meier survival at 1, 5, and 10 years was 99%, 95%, and 88%. In 37 patients, the RAs were not harvested or were not used for grafting because of a positive Allen test, extensive calcification or dissection, intramural hematoma, and scarring from previous arterial lines or catheterization. During postoperative follow-up, five patients (0.32%) were treated for incisional infection, and there were no ischemic hand complications. Three patients had a perioperative myocardial infarction in the RA graft distribution, and 15 patients had a coronary artery reintervention in the RA graft distribution. Two other patients had a percutaneous coronary intervention of their RAs. The overall RA patency at 10 years was 82%.
Conclusions:
Endoscopic harvest of the RA is an excellent minimally invasive conduit harvesting technique with minimal morbidity.
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