Endoscopic Versus Open Radial Artery Harvesting: A Population-Level Analysis.
Academic Article
Overview
abstract
BACKGROUND: Despite increasing radial artery use in multivessel coronary artery bypass grafting (CABG), the optimal harvesting technique remains uncertain. We compared short- and long-term outcomes after multivessel CABG using endoscopic versus open radial artery harvesting at the population level. METHODS: In the Centers for Medicare and Medicaid Services database, 6,840 adults underwent isolated, first-time, multivessel, non-emergent CABG with radial artery use between 2015 to 2022: 3,938 (57.6%) underwent endoscopic and 2,902 (42.4%) underwent open radial harvest. The primary outcome was a composite of major adverse cardiac events (MACE) defined as death, myocardial infarction, or repeat revascularization at 5-years, compared after propensity matching on 26 variables in a Cox proportional hazards model. Secondary outcomes included length of stay, 30-day mortality, 1-year wound and vascular complications. RESULTS: Endoscopic patients were younger (median 69 years [IQR: 66-73] vs 70 years [66-74], p=0.002), less likely female (16.8% vs 19.3%, p=0.008), and had lower prevalence of heart failure (27% vs 30.6%, p=0.001). Propensity matching yielded 2,776 well balanced pairs. Endoscopic patients had shorter hospital stays (6 days [5-9] vs 7 days [5-9], p=0.02), similar 30-day mortality (1.4% vs 1.2%, p=0.35), and similar 1-year wound (4.0% vs 4.8%, p=0.12) and vascular complications (0.3% vs 0.4%, p=0.65) compared to open harvest. Five-year freedom from MACE was equal between groups (81.1% vs 80.8%, HR: 1.02, 95%CI: 0.88-1.18, p=0.83). CONCLUSIONS: There were no differences in late major adverse cardiac events with endoscopic compared to open radial artery harvesting in patients undergoing multivessel CABG.
