Endoscopic versus open radial artery harvesting: a population-level analysis
Allen A. Razavi MD1, Derrick Y. Tam MD PhD1,2, Aminah Sallam MD1, Betemariam Sharew BA1, Claire Perez MD1, Dominic Emerson MD1, Dominick Megna MD1, Tyler Gunn MD1, Mario Gaudino MD PhD3, Michael E. Bowdish MD MS1, Natalia N Egorova PhD4, Joanna Chikwe MD1
1.Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
2.Division of Cardiac Surgery, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
3.Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
4.Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
INTRODUCTION
•Radial artery use at the time of multivessel coronary artery bypass grafting (CABG) has a Class I indication, yet the optimal harvesting technique remains uncertain
•While randomized controlled trials have shown comparable early patency and survival, these studies are limited by small sample sizes, short follow-up, and significant expertise, selection, and publication biases
OBJECTIVE
•To compare long-term major adverse cardiac events after multivessel CABG using endoscopic versus open radial artery harvesting at the population level
METHODS
•We identified 6,840 adults aged ≥ 65 years who underwent isolated, first-time, multi-vessel (2-4 grafts), non-emergent CABG with radial artery use between 2015 to 2022 using the Centers for Medicare and Medicaid database validated against clinical records
•Patients were stratified into endoscopic (n=3,938) and open (n=2,902) radial harvest groups
•Primary endpoint was a composite of major adverse cardiac events (MACE) defined as death, myocardial infarction, or repeat revascularization (PCI or CABG) at 5-years (median follow-up 3.1 years)
•Secondary endpoints included 30-day all-cause mortality, length of stay, and a 5-year MACE stratified by annual endoradial institutional volume
•Outcomes were compared in a Cox-proportional hazard model after 1:1 propensity matching, performed for over 30 pre-operative variables with exact matching for number of bypass grafts
CONCLUSIONS
•In the United States, endoscopic harvesting has emerged as the preferred approach for radial artery conduit procurement during CABG
•Endoscopic radial artery harvesting was associated with reduced length of stay and equivalent short- and long-term outcomes compared to open harvesting
•These findings support the safety and feasibility of endoscopic radial harvesting across a broad range of surgical experience
