Endoscopic Radial Artery Harvesting: Intraoperative, Functional Assessment And Mid-Term Results
Gianluigi Bisleri1, Tomasz Hrapkowicz2, Laura Giroletti1, Marian Zembala2, Claudio Muneretto1.
1University of Brescia Medical School, Brescia, Italy, 2Silesian Center for Heart Disease, Zabrze, Poland.
BACKGROUND: Endoscopic radial artery harvesting (ERAH) has emerged as a feasible procedure for minimally invasive conduits procurement in recent years; however, concerns have been raised about potential endothelial wall injury and spasm following endoscopic harvesting approaches. We therefore sought to evaluate the in situ functional properties of endoscopically harvested radial arteries followed by an angiographic evaluation at mid-term follow-up.
METHODS: Sixteen patients scheduled for CABG surgery underwent ERAH combining a reusable retractor (Endoradial retractor, Karl Storz, Germany) and a nanoscale-controlled, bipolar radiofrequency vessel sealing system (Enseal, Ethicon, USA). Mean age was 58.5±9.9 yrs , diabetes and peripheral vasculopathy were present in 25% (4 pts.) and 37.5% (6 pts.) of patients respectively. Following a 2 cm incision at the wrist crease, endoscopic dissection around the RA was performed uniquely by means of the vessel sealing system. Functional evaluation of the in situ graft reactivity was evaluated by means of transit time flow measurement (TTFM, Medistim, Norway) before conduit harvesting(TTFM#1) once the radial artery has been exposed via the wrist cut-down, once ERAH was completed (TTFM#2) and after ten minutes of topical papaverine application (TTFM#3).
RESULTS: ERAH was successfully performed in all patients: no bleeding was observed from the sealed side branches. No complications requiring conversion to the open technique occurred. Mean harvesting time was 33±7. Basal TTFM#1 was 7.6±0.9 ml/min, while TTFM#2 and TTFM#3 were 9±3.2 and 11±2.7 ml/min respectively. No postoperative hand neurological impairment, vascular compromise or haematoma were reported. At follow-up one patient was lost (non cardiac-related death). At mean follow-up of 1992.5±6.8 days, all remaining patients were in good clinical conditions and had undergone coronary angiography which did not show any occluded radial artery graft.
CONCLUSIONS: ERAH combining a reusable retractor and the Enseal sealing system is a safe and doable procedure. Endoscopic approaches proved to be effective with negligible damage to the harvested conduits at functional analysis. The good performance of radial artery grafts is also established by excellent midterm patency rates in CABG patients.
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