ENDOSCOPIC RADIAL ARTERY HARVEST--OUTCOMES AND LESSONS LEARNED AFTER 1000 HARVESTS

Abstract

Endoscopic radial artery harvest (ERAH) for coronary artery bypass grafting (CABG) offers the potential for decreased pain, infection, neurological complications of the arm with dramatically improved cosmesis compared to an open/conventional harvest. Because of these potential benefits and our experience with endoscopic saphenous vein harvest (ESVH), we adopted ERAH as standard of care for CABG patients at our institution. Here we present our experience and outcomes with this technique after more than 1000 harvests. From July 2004 to present, our centre performed endoscopic radial artery harvest (ERAH) in 1003 patients. We adapted a reusable ESVH system (Karl Storz Endoscopy) with the addition of a harmonic ultrasonic scalpel/shears (Ethicon Endosurgery) to facilitate the removal of the radial artery (RA) for use in our CABG patients. Data was collected prospectively regarding harvest technique (harvest times, graft length, incision length, histology) and patient outcomes (infection, cosmesis, hematomas, gross neurological impairment, patient satisfaction and all MACE’s). Thirty-two patients underwent angiographic assessment of their RA grafts at >5 years. RA Harvest times ranged from 21-125 minutes with a median harvest time of 37min +/- 4 in the first quartile of our series and greatly decreased with experience. Average length of artery extracted was 17.2 cm +/- 1.2 cm through a mean incision length of 2.3 cm +/- 0.7cm. All RA grafts harvested were deemed suitable for grafting. Six patients were converted to open harvest and 15 patients required the addition of a second proximal arm incision. There were 17 ERAH wound infections (1.7%). Neurological impairments were infrequent and mostly consisted of transient numbness over the thenar eminence, index finger and lateral forearm. Five patients manifested clinically significant chronic neuralgias post-operatively. Histological examination of multiple samples of harvested RA’s revealed no signs of intimal trauma or thermal injury. There were no clinically significant hematomas post-operatively and no arm required operative re- intervention. There were 7 postoperative deaths (0.7%), 12 post-op MI’s (1.2%), 22 central neurological complications (2.2%) and no cases of renal failure requiring dialysis. Long-term follow-up on angiography and CT/Angiography revealed a patency rate of 91.3%. ERAH can be effectively and safely adopted as a harvest technique for the RA for CABG. Our results demonstrate ERAH provides adequate length conduits in a timely manner through much smaller incisions, resulting in low rates of infection, neurological impairment, excellent long-term patency and no evidence of histological damage.