Endoscopic versus open radial artery harvesting: A meta-analysis of randomized controlled and propensity matched studies

Abstract

ERAH reduces wound complications and does not affect graft patency, or short- and long-term mortality compared to ORAH.

Endoscopic radial artery harvesting for coronary artery bypass grafting

“…Shapira et al [35] showed that the cost of an endoscopic kit, including the disposable Harmonic shears, is $550. ERAH was also found to take a longer duration as compared to ORAH with an associated steep learning curve in inexperienced hands [36] . The reported learning curve for endoscopic harvest ranges from 5 to 30 cases [37] .…”

“…Finally, a recent meta-analysis of randomized controlled and propensity matched studies comparing the endoscopic approach of harvesting the RA graft with the open approach demonstrated a lower incidence of wound complications [odds ratio (OR) = 0.33, 95% CI: 0.14-0.77, P = 0.01] with similar patency rates and early mortality rates (OR = 1.32, 95% CI: 0.76-2.27, P = 0.32 and OR = 0.78, 95% CI: 0.10-6.11, P = 0.81) [ Figure 2] [57] .…”

“…Less expensive due to fewer pieces of equipment required Expertise [36] Steep learning curve Easier to learn Postoperative [36,[51][52][53][54] Hematoma (post operatively) [54] 5/100 0/100 Wound infection (post operatively) [54] 7/100 1/100 Neuralgia restricting motor function [54] Post operatively 10/100 1/100 Neuralgia restricting motor function [54] At 1 m 8/100 1/100 Neuralgia restricting motor function [54] At 3 m 5/100 0/100 Neuralgia restricting motor function [54] At 6 m 1/100 0/100 Ecchymosis (post operatively) [54] 21/100 2/100 Wound erythema (post operatively) [54] 4/100 0/100 Mild neuralgia [54] Post operatively 31/100 18/100 Mild neuralgia [54] At 1 m 26/100 8/100 Mild neuralgia [54] At 3 m 14/100 4/100 Mild neuralgia [54] At 6 m 7/100 0/100 Patency rate (mid-term follow up period) 91% Vasospasm (post operatively) 0.43% Table 1. Comparison between endoscopic vs .…”

The use of the radial artery following transradial catheterization-A word of caution

“…Due to its improved long‐term patency over saphenous vein grafts and its easy accessibility, the radial artery has become the second most common arterial conduit used in coronary artery bypass graft (CABG) surgery. It can be harvested by either open or endoscopic techniques with minimal trauma, and can be used as a free or composite graft . Its patency, however, may be reduced when the distal target vessel has a <80% stenosis.…”

“…It can be harvested by either open or endoscopic techniques with minimal trauma, and can be used as a free or composite graft. 1 Its patency, however, may be reduced when the distal target vessel has a <80% stenosis. Concerns have also been raised when the radial artery is harvested from patients with longstanding diabetes mellitus and poor glycemic control, as these patients have been shown to have developed intimal changes in their radial arteries when they are examined under electron microscopy.…”