Open radial artery harvesting better preserves endothelial function compared to the endoscopic approach

Gaudino, Mario; Lorusso, Roberto; Ohmes, Lucas B.; Narula, Navneet; McIntire, Patrick J.; Gargiulo, Anna; Bucci, M.; Leonard, Jeremy R.; Rahouma, Mohamed; He, Guo‐Wei; Girardi, Leonard N.; Tranbaugh, Robert F.; Lorenzo, Annarita Di

doi:10.1093/icvts/ivz129

Cited by 21 publications

(11 citation statements)

References 29 publications

(35 reference statements)

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“…In current study we also reported less neurological complications in the endoscopic harvest technique. These findings were also similar to a prospective study in which they reported that the neurological complication reduces from 10 to 0% [19,20]. In our study we We also lack the long term follow up of patients regarding graft patency for each group.…”

Section: Resultssupporting

confidence: 91%

Endoscopic Versus Open Radial Artery Harvesting Used in Coronary Artery Bypass Grafting, Our Experience at Queen Alia Heart Institute

Albkhoor¹,

Hyasat²,

Altaani³

et al. 2021

PBMJ

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Coronary artery stenosis bypass by using radial artery is good techniques which have longer outcomes. In coronary artery bypass grafting (CABG) the radial artery has several advantages. The radial artery has a thick muscular wall which is more susceptible to contraction from the competitive flow. As compared to the open harvesting technique endoscopic harvest of the radial artery has long lasting cosmetic results it also reduces the post-operative complications. The purpose of the study is to compare the two harvesting techniques and compare the short term and long term results related to intra-operative and post-operative outcomes Methods: This is retrospective study (In Queen Alia Heart Institute, Amman ,Jordan) to compare endoscopic radial artery technique versus open technique by reviewing patients files through a period between June 2013 and June 2018. Total 50 patients of CABG surgery was selected they were divided into two groups. Group A includes endoscopic radial harvest (n= 10) and Group B includes open harvest (n=40). Data was collected on predesigned Performa. Data were entered and analyze through IBM SPSS 22.0 Results: There was insignificant dissimilarity between the pre-operative outcomes between groups. The Post-operative outcomes were almost same in both groups except hand numbness (P-value<0.005). The comparison of intraoperative outcomes like harvest time between both groups indicate that the mean harvest time in group A was shorter than group B (39.20 + 3.73 Vs 51.90 + 2.09, P-value=0.000). The operative time in group A was higher than the group B (306.0 + 11.6 Vs 278 + 4.25 p-value=0.00). The hospital stays in both groups were insignificantly different (p = 0.09) Conclusions: Endoscopic radial artery harvest is best suited technique for CABG surgery as it significantly decreases the harvest time as well as hospital stay. It is also proven that it is safer, less painful and better wound appearance technique with exceptional outcomes based on positive surgical experience.

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Section: Resultssupporting

confidence: 91%

Endoscopic Versus Open Radial Artery Harvesting Used in Coronary Artery Bypass Grafting, Our Experience at Queen Alia Heart Institute

Albkhoor¹,

Hyasat²,

Altaani³

et al. 2021

PBMJ

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“…The endoscopic procedure of EAH takes place in a very narrow space, raising the concern of potential mechanical injuries to the conduits, especially on the endothelium. A pathologic examination also showed that RA from OAH had a significantly higher vasodilation response to medications [ 54 ]. However, our statistical analysis suggested that there was no difference in the patency rate between OAH and EAH (RR = 0.91, 95% CI = 0.79 to 1.06, p = 0.23).…”

Section: Discussionmentioning

confidence: 99%

Radial artery harvesting in coronary artery bypass grafting surgery—Endoscopic or open method? A meta-analysis

Huang

Cheng

et al. 2020

PLoS ONE

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We analyzed the clinical outcomes of open radial artery harvesting (OAH) and endoscopic radial artery harvesting (EAH) undergoing coronary artery bypass grafting (CABG). We designed this meta-analysis conducted using Pubmed, Medline, the Cochrane Library, and EMBASE. Articles with comparisons of OAH and EAH undergoing CABG were included. Primary outcomes included the wound infection rate, the wound complication rate, neurological complications of the forearm, in-hospital mortality, long-term survival, and the patency rate. The results of our study included six randomized controlled trials (RCTs), two non-randomized controlled trials (NRCTs) with matching, and 10 NRCTs. In total, 2919 patients were included in 18 studies, while 1187 (40.7%) and 1732 (59.3%) patients received EAH and OAH, respectively. EAH was associated with a lower incidence of wound infection (RR = 0.29, 95% confidence interval (CI) = 0.14 to 0.60, p = 0.03), and neurological complications over the harvesting site (RR = 0.41, 95% CI = 0.27 to 0.62, p < 0.0001). There was no significant difference in 30-day mortality, long-term survival (over one year), and the graft patency rate. According to our analysis, endoscopic radial artery harvesting can improve the outcome of the harvesting site, without affecting the mortality, long-term survival, and graft patency.

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“… 17 , 18 Conversely others have found superior endothelial integrity with ORAH, 18 , 19 and better preservation of endothelial-dependant vasodilatation. 20 ORAH and ERAH are both applicable and after 25 years of evolution both techniques provide similar patency (approximately 90% at 6-10 years) and clinical outcomes. 4 , 16 , 21 ERAH results in better cosmesis and fewer infections.…”

Section: Anatomymentioning

confidence: 93%

The radial artery: An important component of multiarterial coronary surgery and considerations for its optimal harvest

Tatoulis

2021

JTCVS Techniques

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There is mounting evidence from large observational studies and randomized trials (RCTs) that coronary artery bypass grafting using multiple arterial grafts (MAG) results in superior graft patency and better long-term clinical outcomes without compromising perioperative mortality and morbidity. [1][2][3] The radial artery (RA) has emerged as the second arterial graft of choice. It has the same patency as the right internal thoracic artery (ITA) when placed to the same vessels under the same conditions, but is much more versatile and easier to use. 4 Introduced in 1971 by Carpentier, lack of knowledge about arterial graft spasm and management of this with mechanical dilatation was problematic. Observation of excellent, patent, atheroma-free RA grafts from the original series 2 decades later has prompted its reappearance as a coronary graft. Advantages include ease of procurement, length (18-22 cm), robustness, versatility, excellent diameter appropriate to the coronaries, ease of constructing sequential anastomoses, potential for total arterial revascularization when used with the left ITA, especially as a T or Y graft, few infections and wound problems, suitable for use in patients with diabetes, and suitable for use in all ages, including the elderly, facilitating early ambulation. Proximally, its size generally allows direct anastomosis to the aorta or to an ITA. 4 Crucial to successful RA use is optimal harvesting, preparation to maximize its perioperative and long-term efficacy, and minimizing harvest-related complications or impediments. These include wounds, cosmesis, neurologic (particularly sensory) abnormalities, finger/hand ischemia, graft damage (especially intimal), and spasm. Therefore, knowledge of RA anatomy, assessment of hand circulation, its morphologic and pharmacologic characteristics, relationships to relevant nerves, harvest strategies, and a reproducible technique to avoid these potential complications is mandatory. AnatomyThe brachial artery bifurcates into the ulnar artery (UA) and RA at the elbow. The RA is usually smaller and fortuitously is not accompanied by any major nerves-unlike the UA (median nerve). The RA runs deep to the brachioradialis muscle and emerges between it and the flexor muscles approximately two-thirds of the way down the forearm, becoming superficial and easily accessible just above the wrist before its termination in the superficial and deep palmar arches (Figure 1).Proximally, the recurrent RA arises 1 cm distal to the RA origin and runs laterally and proximally. The interosseous artery originates from the deeper aspect. In its proximal two-thirds, the RA lies in loose areolar tissue with few branches. The branches become more numerous in the distal third, particularly around the wrist. Branches on the

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Open radial artery harvesting better preserves endothelial function compared to the endoscopic approach

Cited by 21 publications

References 29 publications

Endoscopic Versus Open Radial Artery Harvesting Used in Coronary Artery Bypass Grafting, Our Experience at Queen Alia Heart Institute

Endoscopic Versus Open Radial Artery Harvesting Used in Coronary Artery Bypass Grafting, Our Experience at Queen Alia Heart Institute

Radial artery harvesting in coronary artery bypass grafting surgery—Endoscopic or open method? A meta-analysis

The radial artery: An important component of multiarterial coronary surgery and considerations for its optimal harvest

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