Sage Journals: Discover world-class research

Abstract

Objective

We reviewed 1577 consecutive patients undergoing coronary artery bypass grafting (CABG) using endoscopic harvesting of the radial artery (RA) to define our current results.

Methods

Since 2000, we have performed endoscopic RA harvest on 1577 consecutive patients; 1476 patients had isolated CABG, and 101 patients had CABG and other procedures. The mean ± SD age was 59.4 ± 9.0 years; 80.2% were men and 40% had diabetes mellitus. All data were prospectively collected. All-cause mortality was determined using the Social Security Death Index.

Results

There were nine in-hospital or 30-day deaths, for an operative mortality of 0.57%: mortality was 0.34% in isolated CABG and 3.85% in CABG/combined procedures. The overall estimated Kaplan-Meier survival at 1, 5, and 10 years was 99%, 95%, and 88%. In 37 patients, the RAs were not harvested or were not used for grafting because of a positive Allen test, extensive calcification or dissection, intramural hematoma, and scarring from previous arterial lines or catheterization. During postoperative follow-up, five patients (0.32%) were treated for incisional infection, and there were no ischemic hand complications. Three patients had a perioperative myocardial infarction in the RA graft distribution, and 15 patients had a coronary artery reintervention in the RA graft distribution. Two other patients had a percutaneous coronary intervention of their RAs. The overall RA patency at 10 years was 82%.

Conclusions

Endoscopic harvest of the RA is an excellent minimally invasive conduit harvesting technique with minimal morbidity.

Keywords

Radial artery Coronary artery bypass grafting Endoscopic technique

Get full access to this article

View all access options for this article.

References

Lytle

B.W.

, Blackstone

E.H.

, Sabik

J.F.

, Houghtaling

, Loop

F.D.

, Cosgrove

D.M.

The effect of bilateral internal thoracic artery grafting on survival during 20 postoperative years. Ann Thorac Surg. 2004; 78: 2005–2012.

Tranbaugh

R.F.

, Dimitrova

K.R.

, Friedmann

Radial artery conduits improve long-term survival after coronary artery bypass grafting. Ann Thorac Surg. 2010; 90: 1165–1172.

Taggart

D.P.

, D'Amico

, Altman

D.G.

Effect of arterial revascularisation on survival: a systematic review of studies comparing bilateral and single internal mammary arteries. Lancet. 2001; 358: 870–875.

Loop

F.D.

, Lytle

B.W.

, Cosgrove

D.M.

Influence of the internal-mammary-artery graft on 10-year survival and other cardiac events. N Engl J Med. 1986; 314: 1–6.

Dimitrova

K.R.

, Hoffman

D.M.

, Geller

C.M.

, Dincheva

, Ko

, Tranbaugh

R.F.

Arterial grafts protect the native coronary vessels from atherosclerotic disease progression. Ann Thorac Surg. 2012; 94: 475–481.

Dimitrova

K.R.

, Hoffman

D.M.

, Geller

C.M.

, DeCastro

, Dienstag

, Tranbaugh

R.F.

Endoscopic radial artery harvest produces equivalent and excellent midterm patency compared with open harvest. Innovations. 2010; 5: 265–269.

Souza

D.S.

, Johansson

, Bojö

Harvesting the saphenous vein with surrounding tissue for CABG provides long-term graft patency comparable to the left internal thoracic artery: results of a randomized longitudinal trial. J Thorac Cardiovasc Surg. 2006; 132: 373–378.

Souza

A new no-touch preparation technique. Technical notes. Scand J Thorac Cardiovasc Surg. 1996; 30: 41–44.

Ronan

J.W.

, Perry

L.A.

, Barner

H.B.

, Sundt

T.M.

III . Radial artery harvest: comparison of ultrasonic dissection with standard technique. Ann Thorac Surg. 2000; 69: 113–114.

10.

Emir

, Gol

M.K.

, Ozisik

Harvesting techniques affect the integrity of the radial artery: an electron microscopic evaluation. Ann Thorac Surg. 2004; 78: 1319–1325.

11.

Zacharias

, Habib

R.H.

, Schwann

T.A.

, Riordan

C.J.

, Durham

S.J.

, Shah

Improved survival with radial artery versus vein conduits in coronary bypass surgery with left internal thoracic artery to left anterior descending artery grafting. Circulation. 2004; 109: 1489–1496.

12.

Desai

N.D.

, Cohen

E.A.

, Naylor

C.D.

, Fremes

S.E.

, for the Radial Artery Patency Study Investigators. A randomized comparison of radial-artery and saphenous-vein coronary bypass grafts. N Engl J Med. 2004; 351: 2302–2309.

13.

Tatoulis

, Buxton

B.F.

, Fuller

J.A.

Long-term patency of 1108 radial arterial-coronary angiograms over 10 years. Ann Thorac Surg. 2009; 88: 23–29.

14.

Buxton

B.F.

, Raman

J.S.

, Ruengsakulrach

Radial artery patency and clinical outcomes: five-year interim results of a randomized trial. J Thorac Cardiovasc Surg. 2003; 125: 1363–1371.

15.

Tabata

, Grab

J.D.

, Khalpey

Prevalence and variability of internal mammary artery graft use in contemporary multivessel coronary artery bypass graft surgery: analysis of the Society of Thoracic Surgeons National Cardiac Database. Circulation. 2009; 120: 935–940.

16.

Borland

J.A.

, Chester

A.H.

, Rooker

S.J.

Expression and function of angiotensin converting enzyme, chymase, and angiotensin II in the human radial artery and internal thoracic artery. Ann Thorac Surg. 2000; 70: 2054–2063.

17.

Briguori

, Testa

, Riccioni

Correlations between progression of coronary artery disease and circulating endothelial progenitor cells. FASEB J. 2010; 24: 1981–1988.

18.

Shapira

O.M.

, Eskenazi

B.R.

, Anter

Endoscopic versus conventional radial artery harvest for coronary artery bypass grafting: functional and histologic assessment of the conduit. J Thorac Cardiovasc Surg. 2006; 131: 388–394.

19.

Brazio

P.S.

, Laird

P.C.

, Xu

Harmonic scalpel versus electrocautery for harvest of radial artery conduits: reduced risk of spasm and intimal injury on optical coherence tomography. J Thorac Cardiovasc Surg. 2008; 136: 1302–1308.

Results of Endoscopic Radial Artery Harvesting in 1577 Patients

Abstract

Objective

Methods

Results

Conclusions

Keywords

Get full access to this article

References