Results of Endoscopic Radial Artery Harvesting in 1577 Patients

Dimitrova, Kamellia R. MD; Dincheva, Gabriela R. BS; Hoffman, Darryl M. MD; DeCastro, Helbert RN; Geller, Charles M. MD; Tranbaugh, Robert F. MD

Innovations: Technology & Techniques in Cardiothoracic & Vascular Surgery: November/December 2013 - Volume 8 - Issue 6 - p 398–402
doi: 10.1097/IMI.0000000000000027
Original Articles

Objective: We reviewed 1577 consecutive patients undergoing coronary artery bypass grafting (CABG) using endoscopic harvesting of the radial artery (RA) to define our current results.

Methods: Since 2000, we have performed endoscopic RA harvest on 1577 consecutive patients; 1476 patients had isolated CABG, and 101 patients had CABG and other procedures. The mean ± SD age was 59.4 ± 9.0 years; 80.2% were men and 40% had diabetes mellitus. All data were prospectively collected. All-cause mortality was determined using the Social Security Death Index.

Results: There were nine in-hospital or 30-day deaths, for an operative mortality of 0.57%: mortality was 0.34% in isolated CABG and 3.85% in CABG/combined procedures. The overall estimated Kaplan-Meier survival at 1, 5, and 10 years was 99%, 95%, and 88%. In 37 patients, the RAs were not harvested or were not used for grafting because of a positive Allen test, extensive calcification or dissection, intramural hematoma, and scarring from previous arterial lines or catheterization. During postoperative follow-up, five patients (0.32%) were treated for incisional infection, and there were no ischemic hand complications. Three patients had a perioperative myocardial infarction in the RA graft distribution, and 15 patients had a coronary artery reintervention in the RA graft distribution. Two other patients had a percutaneous coronary intervention of their RAs. The overall RA patency at 10 years was 82%.

Conclusions: Endoscopic harvest of the RA is an excellent minimally invasive conduit harvesting technique with minimal morbidity.

From the Division of Cardiothoracic Surgery, Beth Israel Medical Center, New York, NY USA.

Accepted for publication September 27, 2013.

Presented at the Annual Scientific Meeting of the International Society for Minimally Invasive Cardiothoracic Surgery, June 12–15, 2013, Prague, Czech Republic.

Disclosure: The authors declare no conflicts of interest.

Address correspondence and reprint requests to Kamellia R. Dimitrova, MD, Division of Cardiothoracic Surgery, Beth Israel Medical Center, 317 East 17th St, 11th Floor, New York, NY 10003 USA. E-mail: kdimitrova2@chpnet.org.

©2013 by the International Society for Minimally Invasive Cardiothoracic Surgery