Endoscopic or Open Radial Artery Harvest in Coronary Artery Bypass Surgery

BACKGROUND: Coronary artery bypass grafting using the radial artery is performed by harvesting the graft through open or endoscopic surgery. Data from randomized trials comparing harvesting techniques are limited.

METHODS: We conducted a randomized controlled trial comparing endoscopic radial artery harvest with open radial artery harvest in adults scheduled for coronary artery bypass surgery. The primary outcome was patient-reported hand function at 3 months after random assignment, assessed using the Hand Function Questionnaire (scores range from 5 to 49, with lower scores indicating more favorable outcomes; a minimal clinically important difference has not been firmly established but may be approximately 3 points). Secondary outcomes included neurologic deficits.

RESULTS: A total of 300 patients were randomly assigned to endoscopic radial artery harvest (151 patients) or open radial artery harvest (149 patients). At 3 months, the mean score on the Hand Function Questionnaire was 7.20 points in patients assigned to endoscopic radial artery harvest and 7.74 points in patients assigned to open radial artery harvest (difference, 0.52 points; 95% confidence interval [CI], 0.06 to 0.98; P=0.03). Thirty-two of 151 (21.2%) patients in the endoscopic radial artery harvest group had neurologic deficits, compared with 82 of 149 (55.0%) patients in the open radial artery harvest group (relative risk with open radial artery harvest, 2.61; 95% CI, 1.90 to 3.63). In the endoscopic radial artery harvest group, one or more serious adverse events occurred in 9 of 151 (6.0%) patients, compared with 4 of 149 (2.7%) patients in the open radial artery harvest group (relative risk with open radial artery harvest, 0.45; 95% CI, 0.13 to 1.34).

CONCLUSIONS: In patients scheduled for coronary artery bypass surgery, endoscopic radial artery harvest, compared with open radial artery harvest, led to modestly better patient-reported hand function and was associated with reduced neurologic deficits. (ClinicalTrials.gov number, NCT01848886.).