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Early and Mid-Term Outcomes of Endoscopic versus Open Radial Artery Harvesting: a Case-Match Study
Gianluigi Bisleri1, Laura Giroletti1, Bruno Guarneri2, Faisal H Cheema3, Claudio Muneretto1.
1Division of Cardiac Surgery - University of Brescia Medical School, Brescia, Italy, 2Section of Neurophysiopathology-Spedali Civili di Brescia, Brescia, Italy, 3Division of Cardiothoracic Surgery - Columbia College of Phisicians & Surgeons, New York, NY, USA.

OBJECTIVE: During the past decade there has been a steady evolution of endoscopic radial artery harvesting (ERAH) techniques as an alternative to the conventional approach in order to increase patients’ satisfaction while reducing pain and wound complications. Nevertheless, the comparison of outcomes either at short and mid-term have been debatable to date.
METHODS: From January 2003 to December 2012, 325 patients underwent CABG at least with a RA conduit: 106 patients were matched according to parameters such as age, sex, diabetes, peripheral artery disease, number of diseased coronary vessels and target anastomotic site(for RA) and assigned either to Group 1(G1,open, n=53) or Group 2(G2,endoscopic, n=53) according to the harvesting technique. Endoscopic harvesting was performed via a reusable retractor and a vessel sealing system. Early and mid term-outcomes were assessed in terms of hand/forearm sensory discomfort (including pain assessment - VAS score, paresthesia and dysesthesia) forearm wound problems (Hollander scale), and RA patency rates. Moreover, electroneuromyography (ENM) was performed in ERAH group to evaluate radial nerve sensory conductions at the harvest site in terms of velocity (SCV), amplitude and latency of sensory nerve action potentials (SNAPs).
RESULTS: No conversion occurred to the open technique in G2. No patients in either group showed hand ischemia; wound infection occurred only in the open group(G1=5% vs G2=0%, p=NS). Wound healing (Hollander scale) was considerably better in the endoscopic group (G1=3.95 vs G2=4.87,p<0.001) as well as neurological(sensory) complications, also at the latest follow-up(G1=10% vs G2=2.5%,p<0.001). Pain(VAS score) was significantly reduced with the endoscopic technique(p<0.05). ENM confirmed normal function of the radial nerve in term of SCV (52 ± 3,8 m/sec), amplitude of SNAPs (11,9 ± 2,7 m/s) and latency of SNAPs (1,9 ±0,3m/s). At the latest follow-up(mean=4.2 yrs), clinical outcomes (angina, CCS class) were similar among the groups with only 1 occluded RA in the open group versus none in the endoscopic one(p=NS).
CONCLUSIONS: Endoscopic radial artery harvesting allows for improved early and mid-term outcomes in terms of improved cosmesis, reduced wound and neurological complications without jeopardizing the integrity of the conduit.


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