Five-Year Clinical Outcome of Endoscopic Versus Open Radial Artery Harvesting: A Propensity Score Analysis.
BACKGROUND
Despite the popularity of less invasive approaches for conduits procurement in coronary artery bypass graft surgery, concerns have been raised about the potential detrimental effects of the endoscopic technique when compared with the conventional "open" technique.


METHODS
Among 470 patients undergoing coronary surgery with the use of a radial artery conduit, a propensity score analysis was performed among those patients assigned either to an open technique (n = 82) or to an endoscopic approach (n = 82). Endoscopic harvesting was performed with a nonsealed system. The primary endpoint was cardiac-related mortality, and secondary endpoint was survival free from major cardiac and cerebrovascular adverse events. Moreover, hand and forearm sensory discomfort and forearm wound healing were also assessed.


RESULTS
No conversion to the open technique occurred in patients undergoing endoscopic harvesting. No patients in either group showed hand ischemia; wound infection occurred only in the open group (open 7.3% versus endoscopic 0%, p = 0.007). Wound healing (Hollander scale) was considerably better in the endoscopic group (open 3.3, endoscopic 4.7; p < 0.001) as well as paresthesia at the latest follow-up (open 19.5% versus endoscopic 3.6%, p < 0.001). Pain (visual analog scale score) was significantly reduced with the endoscopic technique (open 3.2, endoscopic 1.2; p = 0.003). At 5 years of follow-up, freedom from cardiac-related mortality (open 96.3% ± 2.1% versus endoscopic 98.1% ± 1.8%; p = 0.448) as well as survival free from major cardiac and cerebrovascular adverse events (open 93.9% ± 2.6% versus endoscopic 93% ± 3.4%; p = 0.996) were similar among the groups.


CONCLUSIONS
Endoscopic radial artery harvesting allows for incremental benefits in the short term in terms of improved cosmesis and reduced wound and neurologic complications, without yielding detrimental effects in terms of graft-related events at 5 years of follow-up.
Division of Cardiac Surgery, University of Brescia Medical School, Brescia, Italy. Electronic address: gianluigi.bisleri@gmail.com.
Gianluigi
G
Bisleri
Division of Cardiac Surgery, University of Brescia Medical School, Brescia, Italy.
Laura
L
Giroletti
Division of Cardiac Surgery, Silesian Center for Heart Diseases, Zabrze, Poland.
Tomasz
T
Hrapkowicz
Division of Cardiac Surgery, University of Brescia Medical School, Brescia, Italy.
Martina
M
Bertuletti
Division of Cardiac Surgery, Silesian Center for Heart Diseases, Zabrze, Poland.
Marian
M
Zembala
Division of Cardiology, Ospedale di Desenzano, Desenzano, Italy.
Mario
M
Arieti
Division of Cardiac Surgery, University of Brescia Medical School, Brescia, Italy.
Claudio
C
Muneretto
D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000379:methods*; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods*; D023921:Coronary Stenosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D057216:Propensity Score; D017534:Radial Artery / Q000637:transplantation*; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D015996:Survival Rate; D013908:Thoracotomy / Q000379:methods*; D020858:Tissue and Organ Harvesting / Q000379:methods*; D016896:Treatment Outcome