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Results of Endoscopic Radial Artery Harvesting in 1,577 Patients
Kamellia Dimitrova, Gabriela Dincheva, Helbert DeCastro, Darryl Hoffman, Charles Geller, Robert Tranbaugh.
Beth Israel Medical Center, New York, NY, USA.

OBJECTIVE: We reviewed 1,577 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 radial artery harvest on 1,577 consecutive patients; 1,476 patients had isolated, primary CABG and 101 patients had CABG and valve replacement or repair procedures. Average age was 59.4±9.0 years, 80.2% were male and 40% had diabetes mellitus. All data was prospectively collected. All cause mortality was determined using the Social Security Death Index.
RESULTS: There were 9 in-hospital or 30 day deaths for an overall unadjusted operative mortality of 0.57%: mortality was 0.34% in isolated CABG and 3.85% in CABG/valve procedures. The overall estimated Kaplan Meier survival at 1, 5 and 10 years was 99%, 95% and 88%. In 37 other patients, the radial arteries were not harvested or were not used for grafting because of a positive Allen test, extensive calcification or dissection, intramural hematoma and scaring from previous arterial lines or catheterization. The conduit length was consistent between 20 and 25 cm and was used primarily to bypass the left circumflex coronary system. Six percent of patients had both radial arteries harvested endoscopically and another 17.3% of patients had sequential or radial Ygrafts resulting in an average of 3.9 grafts per patient and an average of 2.5 arterial grafts per patient. During postoperative follow-up, 5 patients (0.32%) were treated for incisional infection and there were no ischemic hand complications. Three patients had a perioperative myocardial infarction in the radial artery graft distribution and 15 patients had a coronary artery reintervention in the radial artery graft distribution. Two other patients had a PCI 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 outstanding outcomes with minimal morbidity.


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