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Endoscopic versus open radial artery harvesting for coronary artery bypass grafting: an updated systematic review,
Tayyaba Ikram Qazi1, Aleena Amir Malik2, Mariya Khan2
1Department of Medicine, Khyber Medical College, Peshawar, KPK, Pakistan.
Background:
Endoscopic radial artery harvesting (ERAH) is a minimally invasive alternative to open radial artery harvesting (ORAH) for coronary artery bypass grafting (CABG), though concerns persist regarding graft patency and neurological outcomes.
Methods:
PubMed, Embase, Cochrane Library, and ClinicalTrials.gov were searched through February 21, 2026. Randomized controlled trials and propensity-matched observational studies were included. Risk of bias was assessed using ROB 2 and the Newcastle-Ottawa Scale; certainty of evidence was evaluated using GRADE. Pooled risk ratios and mean differences with 95% confidence intervals were calculated using a random-effects model.
Results:
ERAH significantly reduced wound complications (RR = 0.61, 95% CI: 0.39-0.96) and wound infections (RR = 0.57, 95% CI: 0.35-0.93), though this benefit did not persist in RCT-only analysis. Neurological complications were reduced after sensitivity analysis (RR = 0.44, 95% CI: 0.34-0.57). Graft patency was comparable (RR = 1.01, 95% CI: 0.90-1.14), with no significant differences in mortality, MACCE, or myocardial infarction. Observational data showed modest reductions in cardiopulmonary bypass time and hospital stay.
Conclusions:
ERAH demonstrates comparable graft patency and major clinical outcomes to ORAH. Donor-site benefits suggested by observational studies are not consistently supported by randomized evidence. Large trials with standardized outcomes and long-term follow-up are needed.
Trial Registration:
PROSPERO, CRD420261334767.
