Endoscopic radial artery harvest produces equivalent and excellent midterm patency compared with open harvest.

Overview

abstract

OBJECTIVE: A recent multicenter study reported reduced patency of aortocoronary bypass grafts when the saphenous vein was harvested by endoscopic technique compared with patency of vein grafted after harvest by the traditional "open" approach. Our aim was to compare the patency rates of radial artery graft (RAG) harvested endoscopically with those harvested using an open technique. METHODS: Two cohorts were identified: from January 1995 to January 2000, 724 consecutive patients had one or both radial arteries harvested through an open technique, and from February 2000 to January 2008, 727 consecutive patients had endoscopic radial artery (RA) harvest. All patients who underwent symptom-indicated angiography in our institution at any time after coronary artery bypass grafting (CABG) surgery were identified. RESULTS: Two hundred two patients had angiograms for symptoms: 90 of these patients (119 RAG) had open RA harvest and were studied 78.3 ± 40 months (range, 1-156 months) after CABG. The other 112 patients (148 RAG) had endoscopic RA harvest and underwent angiography 36 ± 24 months (range, 1-96 months) after CABG. The two groups had identical demographics and risk profiles. Overall patency of the "open" RAG was 78.9% versus 83.7% for the endoscopic group (P = 0.3). Patency increased to 90% in both groups when the RAG was anastomosed to a native coronary vessel with stenosis >80%. CONCLUSIONS: Endoscopic and open RA harvesting techniques have equivalent and excellent midterm and long-term patency rates in CABG patients studied by angiography for recurrent symptoms of myocardial ischemia. The degree of stenosis of the target vessel strongly influences the patency rate independent of the harvesting technique.