Prospective randomized trial of endoscopic vs open radial artery harvest
for CABG: clinical outcome, patient satisfaction and mid-term RA graft
patency.
Abstract
Background and Aim Endoscopic radial artery (RA) harvest (ERAH) is an
alternative to open RA harvest (ORAH) technique. Our aim was to compare
clinical outcome, patent satisfaction and 1-year angiographic patency
rates after ERAH and ORAH. Patients and methods 50 patients undergoing
multivessel CABG were prospectively randomized to two groups. In the
ERAH group (25 patients) the RA was harvested endoscopically and in the
ORAH group (25 patients) openly. Results There were not differences
between the groups in preoperative characteristics. Length of skin
incision was shorter in ERAH (p<0.001) but there were not
differences in the length of RA, harvest time, blood flow and
pulsatility index after ERAH and ORAH. Wound healing was uniformly
smooth in ERAH and there were 2 haematomas and 1 infection in ORAH.
Postoperatively, major neuralgias were present in 5 patients in ORAH and
none in ERAH (p=0.05) and minor neuralgias in 11 and 3 patients (p=0.02)
respectively. Twenty-four patients in ERAH and 4 in ORAH graded their
experience as excellent (p<00001). One-year angiographic RA
patency was 90% without intergroup difference. Target vessel stenosis
< 90% adversely affected RA patency (p<0.0001).
Conclusions In expert center, ERAH has no negative impact on time
harvest, length and quality of RA conduit. Moreover, ERAH may provide
better wound healing, and is associated with less neuralgias, excellent
cosmetic result and better patient satisfaction. RA graft patency is
unaffected by the harvesting technique and is excellent when placed to a
target coronary artery vessel with stenosis > 90%.