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Endoscopic Versus Open Radial Artery Harvesting in Coronary Artery Bypass Grafting: A Systematic Review and
Rahul Balach1, Ayan Khalid2, Faiza Hayat Qadri3
1From the Ziauddin University, Karachi, Pakistan.
Insights
Endoscopic radial artery harvesting (ERAH) is a safer alternative to open radial artery harvesting (ORAH) for coronary artery bypass grafting, reducing wound and neurological complications without impacting graft success.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Techniques
- Surgical Outcomes Research
Background:
- The radial artery is a preferred graft in coronary artery bypass grafting (CABG) due to excellent long-term patency.
- Open radial artery harvesting (ORAH) is linked to significant wound and neurological complications.
- Endoscopic radial artery harvesting (ERAH) offers a minimally invasive approach, but its comparative effectiveness needs clarification.
Purpose of the Study:
- To systematically evaluate the safety and efficacy of ERAH versus ORAH in CABG patients.
- To compare wound complications, neurological deficits, and graft outcomes between ERAH and ORAH.
Main Methods:
- A systematic review and meta-analysis of randomized controlled trials (RCTs) comparing ERAH and ORAH.
- Searched PubMed, ScienceDirect, and Cochrane Library up to January 2026.
- Pooled risk ratios (RRs) with 95% confidence intervals (CIs) using random-effects models.
Main Results:
- Eight RCTs with 914 patients were analyzed.
- ERAH significantly reduced overall wound complications (RR: 0.51; 95% CI, 0.32-0.79) and hematoma (RR: 0.24; 95% CI, 0.07-0.78).
- ERAH also showed a significant reduction in neurological deficits (RR: 0.47; 95% CI, 0.36-0.62) compared to ORAH.
Conclusions:
- ERAH is associated with fewer wound complications, hematomas, and neurological deficits compared to ORAH.
- The study supports ERAH as a safe, minimally invasive alternative for CABG.
- Graft patency and mortality rates were comparable between the two harvesting methods.
Abstract:
The radial artery is a commonly used conduit in coronary artery bypass grafting (CABG) due to its favorable long-term patency. However, conventional open radial artery harvesting (ORAH) is associated with wound and neurological morbidity. Endoscopic radial artery harvesting (ERAH) has emerged as a minimally invasive alternative, but its comparative safety and efficacy remain uncertain. PubMed, ScienceDirect, and the Cochrane Library were systematically searched from inception to January 2026 for randomized controlled trials comparing ERAH with ORAH in patients undergoing CABG. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using random-effects models. Primary outcomes included wound infection, overall wound complications, and neurological complications. Secondary outcomes included graft patency, hematoma, neurological deficit, stenosis, occlusion, and mortality. Eight randomized controlled trials involving 914 patients were included. ERAH was associated with a significantly lower risk of overall wound complications (RR: 0.51; 95% CI, 0.32-0.79; P = 0.003), hematoma (RR: 0.24; 95% CI, 0.07-0.78; P = 0.02), and neurological deficits (RR: 0.47; 95% CI, 0.36-0.62; P < 0.0001) compared with ORAH. No significant differences were observed in wound infection, overall neurological complications, graft patency, stenosis, occlusion, or mortality. ERAH reduces wound complications, hematoma, and neurological deficits without compromising graft patency or increasing mortality, supporting its use as a safe minimally invasive alternative to ORAH in CABG. Registration: PROSPERO (CRD420261333569).
