CLINICAL OUTCOMES ASSOCIATED WITH ENDOSCOPIC RADIAL ARTERY HARVEST: A SYSTEMATIC REVIEW AND SELECTIVE META-ANALYSIS

Abstract

Currently there is no consensus on the safety and efficacy of endoscopic radial artery harvest. We sought to accurately compare selected clinical outcomes associated with radial artery harvesting between open and endoscopic techniques by synthesizing the available evidence and employing more appropriate statistical MethodS: than currently reported. A systematic computer-based search was undertaken using the PubMed and EMBASE databases. Articles were screened for relevance by title, abstract, and full text review using predefined selection criteria. Eleven relevant prospective (or retrospective cohort) studies were selected comparing the outcomes of graft function, harvest site infection, neurologic injury, or patient satisfaction/cosmetics. Seven case series were also evaluated for consistency of results. Using random-effects meta-analysis, the outcomes of graft function (measured by patency) and harvest site infection were synthesized to derive a pooled risk ratio (RR) for the event. Where studies contained instances of non-events, a continuity correction using the inverse of the opposite treatment group was employed. Neurologic injury and patient satisfaction/cosmetics faced extensive methodological heterogeneity, and were deemed inappropriate for meta-analysis. Studies had small populations and outcomes were often secondary in nature. No statistically significant difference was found between open and endoscopic harvest with respect to graft function (RR 0.94, 95% CI: 0.58-1.52). Contrary to previous evidence, no statistical difference was found in incidence of harvest site infection between the two groups (RR 0.38, 95% CI: 0.15-1.00). A differential effect on neurologic injury was observed, where endoscopic harvest eliminated lateral antebrachial cutaneous nerve injury, though was still susceptible superficial radial nerve injury. In both groups, neurologic symptoms tended to resolve by 3-6 months. Patient satisfaction and cosmetics favoured the endoscopic group, though formal statistical analysis was not possible. After systematically reviewing the literature and selectively employing random-effects meta-analytical MethodS:, statistical equivalence for both graft patency and harvest site infection was demonstrated between open and endoscopic radial artery harvest. Neurologic injury tended to be equivalent between groups at 3-6 months post-operatively, though territories were differentially affected. Patient satisfaction/cosmetic results favoured the endoscopic group. This analysis provides evidence more robust than has been recently reported, but it is recognized that a definitive trial on this subject has yet to be published.