Can harvesting techniques modify postoperative results of the radial artery conduit?
BACKGROUND
Inappropriate harvesting of arterial conduits can lead to severe postoperative complications. We analyzed clinical and functional results of patients undergoing radial artery (RA) harvesting by means of three techniques.


METHODS
From January 2001 to January 2004 188 patients undergoing coronary artery bypass graft with RA were divided into three groups: harmonic scalpel was employed in 61 (RA1), electrocautery in 63 (RA2), Potts-scissors and clips in 64 (RA3) patients. Harvesting time, local complications, number of clips employed, graft flowmetry, postoperative troponin I, incidence of re-exploration for bleeding due to the graft were analyzed.


RESULTS
RA1 and RA2 showed a lower harvesting time (RA1 16.2 +/- 8.4 vs RA3 41.4 +/- 7.7 min, p = 0.0001; RA2 21.1 +/- 10.4 min, p = 0.001). Postoperative hand paresthesia was detected in RA1 (5/61; 8.2%) and RA2 (5/63; 7.9%), but not in RA3 (p = 0.048 and p = 0.05, respectively). More clips were necessary in RA3 compared to RA2 (p = 0.04) or RA1 (p = 0.0001 vs RA3; p = 0.001 vs RA2). RA1 showed significant higher values of maximum flow (RA1 59.4 +/- 37.5 vs RA2 22.1 +/- 7.7 ml/min, p = 0.0001; vs RA3 31.3 +/- 12.0 ml/min, p = 0.001), mean flow (RA1 23.4 +/- 17.3 vs RA2 10.2 +/- 5.7 mi/min, p = 0.001; vs RA3 11.6 +/- 8.9 ml/min, p = 0.001), minimum flow (RA1 11.6 +/- 6.5 vs RA2 4.2 +/- 3.7 ml/min, p = 0.01; vs RA3 4.7 +/- 3.3, p = 0.03), and pulsatility index (RA1 0.9 +/- 0.8 vs RA2 2.1 +/- 1.3, p = 0.03; vs RA3 1.7 +/- 2.1, p = 0.04). Troponin I was significantly lower in RA1, compared to RA2 and RA3 at 12 hours (p = 0.01 and p = 0.03, respectively) and 24 hours (p = 0.05 and p = 0.045, respectively). No RA1 patient underwent re-exploration for bleeding compared to RA2 (p = 0.011) and RA3 (p = 0.02).


CONCLUSIONS
RA harvesting with ultrasounds is fast, determines high flowmetry values, low enzyme release and rarely causes local complications.
Onorati
Francesco
F
Cardiac Surgery Unit, Magna Graecia University, Catanzaro, Italy. frankono@libero.it
De Feo
Marisa
M
Cristodoro
Lucia
L
Esposito
Antonio
A
Perrotti
Andrea
A
Mastroroberto
Pasquale
P
Renzulli
Attilio
A
Cotrufo
Maurizio
M
D000368:Aged; D001783:Blood Flow Velocity / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000097:blood / Q000601:surgery*; D009204:Myocardial Revascularization / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control; D011673:Pulsatile Flow / Q000502:physiology; D017534:Radial Artery / Q000503:physiopathology / Q000637:transplantation*; D012189:Retrospective Studies; D020858:Tissue and Organ Harvesting / Q000379:methods*; D016896:Treatment Outcome; D020107:Troponin T / Q000097:blood
D020107:Troponin T