Endoscopic Versus Open Radial Artery Harvesting: A Population-Level Analysis

Despite increasing radial artery use in multivessel coronary artery bypass grafting (CABG), the optimal harvesting technique remains uncertain. We compared short- and long-term outcomes after multivessel CABG using endoscopic vs open radial artery harvesting at the population level.

In the Centers for Medicare and Medicaid Services database, 6840 adults underwent isolated, first-time, multivessel, nonemergent CABG with radial artery use between 2015 and 2022: 3938 (57.6%) underwent endoscopic and 2902 (42.4%) underwent open radial harvest. The primary outcome was a composite of major adverse cardiac events defined as death, myocardial infarction, or repeat revascularization at 5 years, compared after propensity matching on 26 variables in a Cox proportional hazards model. Secondary outcomes included length of stay, 30-day mortality, and 1-year wound and vascular complications.

Endoscopic patients were younger (median, 69 [interquartile range-IQR, 66-73] years vs 70 [IQR, 66-74] years, P = .002), less likely female (16.8% vs 19.3%, P = .008), and had lower prevalence of heart failure (27% vs 30.6%, P = .001). Propensity matching yielded 2776 well-balanced pairs. Endoscopic patients had shorter hospital stays (6 [IQR, 5-9] days vs 7 [IQR, 5-9] days, P = .02), similar 30-day mortality (1.4% vs 1.2%, P = .35), and similar 1-year wound (4.0% vs 4.8%, P = .12) and vascular complications (0.3% vs 0.4%, P = .65) compared to open harvest. Five-year freedom from major adverse cardiac events was equal between groups (81.1% vs 80.8%, hazard ratio, 1.02; 95% CI, 0.88-1.18; P = .83).

There were no differences in late major adverse cardiac events with endoscopic compared to open radial artery harvesting in patients undergoing multivessel CABG.