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Comparable Assessment of Perioperative and Postoperative Outcomes in Open Versus Endoscopic Radial Artery Harvest for
Shehdev Meghwar1, Amna Parvez2, Sabahat Ul Ain Munir Abbasi3
1Nursing & Midwifery Research Department, Hamad Medical Corporation, Doha, Qatar.
Insights
Endoscopic radial artery harvesting for coronary artery bypass grafting significantly reduces wound and neurological complications. This method offers comparable graft patency and short-term outcomes to open harvesting, making it a safer alternative.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Techniques
- Evidence-Based Medicine
Background:
- Coronary artery bypass grafting (CABG) is a primary treatment for multivessel coronary disease.
- The radial artery (RA) is a favored graft due to its favorable long-term patency.
- The optimal surgical technique for RA harvesting (endoscopic vs. open) in CABG remains debated.
Purpose of the Study:
- To systematically review and meta-analyze randomized controlled trials comparing endoscopic versus open radial artery harvesting in CABG.
- To evaluate the impact of harvesting technique on wound complications, neurological complications, graft patency, mortality, and reoperation rates.
Main Methods:
- Systematic review and meta-analysis adhering to PRISMA 2020 guidelines.
- Comprehensive literature search of PubMed, Embase, Cochrane Library, and Scopus up to January 2026.
- Random-effects model analysis using R, with Risk of Bias 2 tool for quality assessment.
Main Results:
- Endoscopic RA harvesting significantly reduced wound infections (RR 0.58, P=0.03) and neurological complications (RR 0.47, P<0.0001) compared to open harvesting.
- Graft patency, reoperation rates, in-hospital/30-day mortality, and length of hospital stay showed no significant differences between groups.
- Endoscopic harvesting was associated with a longer harvest time (MD 11.44 minutes, P=0.04) but not aortic clamp time.
Conclusions:
- Endoscopic radial artery harvesting in CABG surgery leads to fewer wound and neurological complications.
- The technique demonstrates comparable graft patency and short-term clinical outcomes to conventional open harvesting.
- Endoscopic harvesting presents a safer alternative for radial artery procurement in CABG procedures.
Abstract:
Coronary artery bypass grafting (CABG) is the standard treatment for multivessel coronary disease. The radial artery (RA) is commonly used because of its good long-term outcomes. RA can be harvested using either endoscopic or open techniques, but the optimal method remains unclear. This systematic review and meta-analysis compares outcomes between both approaches in CABG procedures. This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. PubMed, Embase, Cochrane Library, and Scopus were searched up to January 2026 for randomized controlled trials comparing endoscopic versus open RA harvesting in CABG. Data were analyzed using a random-effects model in R (version 4.5.2), with risk of bias 2 used for bias assessment. Outcomes assessed included wound and neurological complications, along with graft patency, mortality, and reoperation. Pooled analysis showed a significant reduction in wound infections (risk ratio, 0.58; P = 0.03) and neurological complications (risk ratio, 0.47; P < 0.0001) with endoscopic compared with conventional open harvesting, with consistent results across various follow-up periods. Graft patency showed similar results in both groups (P = 0.49), with no significant differences in reoperation (P = 0.33), in-hospital/30-day mortality (P = 0.47), or length of hospital stay (P = 0.16). However, endoscopic harvesting showed a significant increase in harvest time compared with open harvesting (mean difference, 11.44 minutes; P = 0.04), with no significant differences in aortic clamp time (P = 0.96). Endoscopic RA harvesting in CABG surgery showed significantly reduced wound infections and neurological complications without affecting graft patency or short-term outcomes.
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