Endoscopic Radial Artery Harvesting Combining a Reusable Retractor With a Nanoscale-controlled Radiofrequency Vessel Sealing System: Early Histological Analysis and Late Clinical Outcomes
Gianluigi Bisleri1, Laura Giroletti1, Tomasz Hrapkowicz2, Jerzy Nozyski2, Marian Zembala2, Claudio Muneretto1.
1University of Brescia Medical School, Brescia, Italy, 2Silesian Center for Heart Diseases, Zabrze, Poland.
OBJECTIVE: Despite the proven clinical advantages of an endoscopic approach over a conventional technique for radial artery harvesting, there are potential concerns about conduit damage occurring during minimally invasive procurement which could lead to late graft failure. We therefore sought to investigate the histological features of radial artery conduits immediately after endoscopic harvesting and the potential correlation with late clinical outcomes.
METHODS: In 36 patients undergoing CABG surgery, radial artery harvesting was performed by means of an endoscopic (non-sealed) technique combining a reusable stainless steel retractor and a nanoscale-controlled bipolar radiofrequency device as a vessel sealing system. Immediately after endoscopic harvesting, a sample of the radial artery was fixated with 6% neutral formalin solution and embedded in paraffin: histological analysis of five micron sections by means of haematoxylin-eosin, Masson trichrome and acid orcein was performed and a semiquantitative 0- to 4-point scale utilized in order to grade potential conduit wall damage. A clinical follow-up was performed in all patients.
RESULTS: Endoscopic radial artery harvesting was successfully completed in all cases(mean harvesting time: 29±4 minutes) without intra-operative complications. No bleeding from the sealed side branches requiring additional clips application was required. Histological analysis did not reveal significant acute pathological changes occurring to the radial artery integrity either in terms of endothelial loss(0.9±0.4), injury to the internal lamina elastica(0.5±0.3), adventitial hemorrhage(0.5±0.2), vasa vasorum heat-related damage(0.1±0.3) and margination of white blood cells(0.6±0.3) . The post-operative period was uneventful in all cases. Mean follow-up was 1893+546 days: cardiac-related late mortality occurred only in 1 patient (patent RA on autopsy). Coronary angiography was performed in 5 patients due to angina recurrence: excellent graft patency(Fitzgibbon grade A) was detected in all radial artery conduits.
CONCLUSIONS: Endoscopic harvesting of the radial artery with a non-sealed approach combining a reusable stainless steel retractor with a nanoscale-controlled bipolar radiofrquency vessel sealing system was associated with negligible damage to the integrity of the radial artery graft at histological analysis immediately after harvesting. Moreover, no detrimental effects of this approach could be detected at mid-long term follow-up as confirmed by the excellent clinical and angiographic results.
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