Mid-Term Clinical Outcomes Of

Endoscopic versus Open Radial Artery

Harvesting:

a Propensity-score Analysis

Bisleri G1, Giroletti L1, Hrapkowicz T2, Bertuletti M1, Zembala M2,

Arieti M3, Muneretto C1

1University of Brescia Medical School, Brescia, Italy2Silesian Center for Heart Diseases, Zabrze, Poland

3Ospedale di Desenzano, Desenzano, Italy

FINANCIAL DISCLOSURES

- GIANLUIGI BISLERI, MD:

- Karl Storz Gmbh: Inventor, Consultant

- Covidien AG: Consultant

ENDOSCOPIC RADIAL ARTERY HARVESTING

- Revival of radial artery as second conduit of choice for TAR

ENDOSCOPIC RADIAL ARTERY HARVESTING

- Revival of radial artery as second conduit of choice for TAR

- Encouraging outcomes following endoscopic radial harvesting

ENDOSCOPIC RADIAL ARTERY HARVESTING

ENDOSCOPIC RADIAL ARTERY HARVESTING

- Revival of radial artery as second conduit of choice for TAR

- Encouraging outcomes following endoscopic radial harvesting

- Improved technologies for minimally invasive harvesting techniques

ENDOSCOPIC RADIAL ARTERY HARVESTING

SEALED

SYSTEMS

NON-SEALED

SYSTEMS

CO2 insufflation

IS REQUIRED

CO2 insufflation

NOT REQUIRED

ENDOSCOPIC RADIAL ARTERY HARVESTING

- Revival of radial artery as second conduit of choice for TAR

- Encouraging outcomes following endoscopic radial harvesting

- Improved technologies for minimally invasive harvesting techniques

- Potential concerns about detrimental effect of endoscopic technique

ENDOSCOPIC RADIAL ARTERY HARVESTING

- Compare outcomes following OPEN vs ENDOSCOPIC – RA harvesting

- Endoscopic technique with a NON-SEALED approach

STUDY OBJECTIVE

SURGICAL TECHNIQUE

END-POINTS

- PRIMARY:

- Cardiac related mortality

- SECONDARY:

- Freedom from MACCEs (cardiac related mortality,

MI, PTCA re-intervention, REDO surgery, stroke)

- Freedom from sensory discomfort

(pain assessment - VAS score, dysesthesia)

- Forearm wound healing (Hollander scale)

STUDY POPULATION

420 patients

undergoing CABG

Open RA

Harvesting

(Group 1)

n° =313

Endoscopic RA

Harvesting

(Group 2)

n° = 107

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Group 1

Group 2

PRE- MATCH CHARACTERISTICS

*

*

*

P<0.05*

164 patients

Open RA

Harvesting

(Group 1)

n° = 82

Endoscopic RA

Harvesting

(Group 2)

n° = 82

PROPENSITY-MATCHED POPULATION

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Group 1

Group 2

POST- MATCH CHARACTERISTICS

P= NS

0

10

20

30

40

50

60

70

80

90

100

RA on RCA RA on IVP RA on OM RA on PL

Group 1

Group 2

P = NS%

RA TARGET SITE

RCA PDA OM PL

Group 1

Open RA

Harvesting

Group 2

Endoscopic RA

Harvesting

p-Value

Mean RA Harvesting time (min) 40,2 ± 3 37.5 ± 5 0.309

Mean n° graft / patient 2.39 ± 0.68 2.5± 0.71 0.960

Cross Clamp time (min) 53.2 ± 12.1 51.6 ± 9.4 0.923

CPB time (min) 85.2 ± 11.3 88.1 ± 7.2 0.553

INTRA-OPERATIVE CHARACTERISTICS

No conversion to open approach in endoscopic group

Group 1

Open RA

Harvesting

Group 2

Endoscopic RA

Harvesting

P Value

Hand Ischemia 0 0 1

Wound Infection 6 (7.3%) 0 0.007

Sensory alteration 18 (21.9%) 7 (8.5%) 0.0082

Pain (VAS score) 3.2 1.2 <0.05

Wound Healing

(Hollander scale)

3.95 5.1 <0.001

POST-OPERATIVE RA OUTCOMES

P = 0,448

G1: 96,3 ± 2,1%

G2: 98,1 ± 1,8 %

G1 82 80 80 79 79 78

G2 82 72 60 53 51 47

FOLLOW-UP @ 5 YEARS

CARDIAC RELATED MORTALITY

Patients at

risk

G1 82 81 78 77 77 76

G2 82 75 67 53 51 45

G1: 93,9 ± 2,6 %

G2: 93,0 ± 3,4 %

P= 0,996

FOLLOW-UP @ 5 YEARS

MACCEs

Patients at

risk

FOLLOW-UP @ 5 YEARS

NEUROLOGICAL DISCOMFORT

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Open Group Endoscopic Group

P=0,009

CONCLUSION

-ERAH can be safely performed combining a reusable

retractor and impedance-controlled RF vessel sealer.

-ERAH allows for improved cosmesis, reduced wound and

neurological complications at short term.

-The endoscopic approach IS NOT associated with

detrimental effects in terms of graft related events at 5

years follow-up.