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Endoscopic versus Conventional Harvesting of the Radial Artery in Coronary Artery Bypass Grafting- A Prospective Randomized Control Trial
Bob Kiaii, Stuart Swinamer, Stephanie Fox, Larry Stitt, MacKenzie Quantz, Michael Chu, Ray Guo, Richard Novick.
London Health Sciences Center, London, ON, Canada.

Objective: Our objectives were (1) to determine if minimally invasive endoscopic harvesting of the radial artery reduces morbidity due to pain, infection, and disability with improvement in satisfaction and cosmesis compared to the conventional technique and (2) to compare the 6 month angiographic patency of the radial artery harvested conventionally and endoscopically.
Methods: In a prospective study, 119 patients undergoing coronary artery bypass grafting using the radial artery were randomized to have radial artery harvested either using conventional method (n=59) or endoscopic minimally invasive method (n=60).
Results: Radial artery harvest time (open wound time) was significantly reduced in the endoscopic group (36.5 ± 9.4 vs 57.7 ± 9.4 minutes, p< .001). Only one patient developed wound infection (1.6%) in the endoscopic group compared to 6 patients (10.2%), p=.061 in the conventional group. Although this was not statistically significant, clinically this was relevant in terms of reduction in postoperative morbidity. Postoperative pain in the arm incision was significantly lower in the endoscopic group at postoperative day 2 (p<.001) and at discharge (p<.001) and similar to the conventional open group at 6 weeks follow-up (p=.103). Overall patient satisfaction and cosmesis were significantly better in the endoscopic group at postoperative day 2 (p<.001), at discharge (p<.001), and at 6 weeks follow-up (p<.001). There was no difference in the arm disability postoperatively based on the DASH ( Disabilities of the Arm, Shoulder and Hand) score (p= .505) between the endoscopic and conventional harvesting group. Six month angiographic assessment of 23 patients (12 endoscopic and 11 open conventional) revealed no difference in the number of patent radial arteries (10/12 in endoscopic and 9/11 in open conventional group).
Conclusion: Endoscopic radial artery harvesting significantly reduced postoperative wound pain, improved patient satisfaction and cosmesis, and also reduced the incidence of wound infection compared to conventional harvesting technique. There was no difference in the 6 month angiographic patency of the radial artery harvested conventionally and endoscopically.


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