Long Term Patency Of Endoscopically Harvested Radial Artery From A Randomized Control Trial
Daniel Jp Burns, MD, Stuart A. Swinamer, MD, Stephanie A. Fox, RRCP, Jonathan Romsa, MD, William Vezina, MD, Cigdem Akincioglu, MD, James Warrington, MD, Lin-Rui Guo, MD, Michael Wa Chu, MD, Mackenzie A. Quantz, MD, Richard J. Novick, MD, Bob Kiaii, MD.
London Health Sciences Center, London, ON, Canada.
Objective: From 2005-2007, 119 patients were enrolled in a prospective randomized controlled trial comparing open and endoscopically harvested radial arteries for coronary artery bypass grafting (CABG). This trial showed equivalent postoperative arm disability, and in the endoscopic group, postoperative arm pain, cosmesis, and patient satisfaction were significantly improved, with a trend toward a significant decrease in wound infections observed. The objective of the current study was to compare graft patency between open and endoscopically harvested radial arteries at greater than 5 years from involvement in the stated trial. We hypothesized that endoscopically harvested radial arteries would show equivalent patency.
Methods: All patients received calcium channel blocker therapy for at least 6 months postoperatively. The mean duration of follow-up was 79.2 (+/- 8.6) months for all patients. At 5 years or greater from their operation, all consenting patients underwent a single-day anatomic and functional cardiac assessment with CT angiography and sestamibi myocardial perfusion scanning. Medical Outcomes Study 36-Item Short Form Health Surveys and Seattle Angina Questionnaires were completed to assess overall quality of life.
Results: Two deaths occurred within 30 days of CABG (one in each treatment group) and 8 additional non-cardiac deaths occurred over the study timeframe. Of 119 patients, 66 consented to follow-up. Thirty-two had open radial artery harvest and 34 had endoscopic radial artery harvest. In the open group, there were 11 obtuse marginal, 16 posterior descending, 1 posterolateral, and 4 right coronary grafts. In the endoscopic group, there were 7 obtuse marginal, 14 posterior descending, 3 posterolateral, 1 circumflex, 1 diagonal, 1 ramus intermedius, and 7 right coronary grafts. There were 28 (87.5%) patent conventionally harvested radial arteries and 31 (91.2%) patent endoscopically harvested radial arteries (p=0.705). Measured quality of life was comparable between groups.
Conclusion: Endoscopic radial artery harvest is safe and effective when compared to open radial artery harvest, with equivalent graft patency shown at greater than 5 years.
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