Graft patency was assessed in selected studies by coronary angiography or computed tomography angiography at the time of discharge or postoperative follow-up. When both investigations were performed, data from coronary angiography were selected for analysis because it remains to be the standard investigation to assess graft patency. A graft was considered “patent” as defined by individual studies, including those grafts that were perfectly patent, grafts that were patent with minor irregularities, or grafts that did not demonstrate occlusion or stenosis.10,12,15 Two studies reported graft patency outcomes according to the number of grafts (88.7% vs 85.8%; RR, 1.04; 95% CI, 0.97–1.12; P = 0.24; I 2 = 0%), and two studies reported the number of patients who had patent grafts at follow-up (75.9% vs 78.1%; RR, 1.00; 95% CI, 0.83-1.21; P = 0.97; I 2 = 0%, Fig. 4). Neither measurements reached statistical significance comparing endoscopic versus open techniques.
Since the introduction of antispasmodic medications and improvements in surgical techniques in the 1990s, there has been a growing interest in the use of the radial artery as a conduit for CABG. Although patients with less severe native coronary artery disease (<90% stenoses) have been shown to have worse patency outcomes,10,23 available evidence suggests that the radial artery is associated with superior angiographic outcomes at short-term and midterm follow-up compared with saphenous veins. Meta-analysis of randomized controlled trials have established higher incidences of complete patency as well as lower incidences of graft occlusion and graft failure after CABG using the radial artery.4,5 Nonetheless, concerns about the angiographic finding of the “string sign” persist, and patient selection in the randomized trials was strictly limited to severe (>70% stenoses) target vessel lesions.
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grafts harvested by minimally invasive surgery—immunohistochemical studies of CD31 and endothelial nitric oxide synthase expressions: a randomized controlled trial. Eur J Cardiothorac Surg. 2011; 39: 471–477.
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This meta-analysis examined endoscopic versus conventional open radial harvesting for coronary artery bypass graft surgery. Twelve studies involving more than 3000 patients were examined. There were no significant differences in overall mortality, recurrent myocardial infarction, or graft patency between the two techniques. However, patients who underwent endoscopic harvesting were found to have a significantly lower incidence of wound infections, hematoma formation and paresthesias.
This meta-analysis suggests that the endoscopic approach has superior perioperative outcomes without compromising short-term results. However, there are weaknesses in this analysis. None of the studies that were examined were randomized, and hence, all may have been subjected to patient selection bias. Finally, the follow-up periods were relatively short, and only one of the studies looked at even medium-term outcomes. Keeping these limitations in mind, this study suggests that endoscopic harvesting of the radial artery is a safe procedure in the short-term and may offer superior perioperative outcomes in terms of wound complications. However, if there was a difference in long-term patency between these techniques, these advantages would be nullified. Future studies in this area are keenly anticipated.