Cost Effective Endoscopic Radial Artery Harvesting

Cost Analysis of Endoscopic Conduit Harvesting Technique Using a Non-Sealed System for Coronary Artery Bypass Surgery

Objective: Endoscopic vessel harvest (EVH) is evolving as the standard of care for coronary artery bypass grafting. However, the increase in upfront equipment-related costs has resulted in reluctance of uptake globally. We investigated the costs involving a non-sealed technique for EVH versus open vessel harvesting techniques (OVH) for both the greater saphenous vein and radial artery with a 6-month follow-up. Methods: From September 2016 to December 2018, 226 patients underwent OVH while 251 patients underwent EVH using a reusable non-sealed system and a single-use radiofrequency sealing system. Cumulative costs for OVH versus EVH were calculated as a summation of total operative and in-hospital stay costs. Costs related to harvest site complication management were also analyzed for up to 6 months. Results: Total operative costs were greater in the EVH group (Can$2,283.70 [Can$1,377.60 to $4,183.50] vs Can$1,742.40 [Can$998.50 to $3,628.10], P < 0.001). Total length of stay was significantly shorter for the EVH group (5.9 [4 to 43] days vs 6.8 [4 to 55] days, P = 0.018). Cumulative costs were comparable at the end of the hospitalization period (EVH, Can$6,534.70 [Can$2,076.50 to $33,087.70] vs OVH, Can$6,112.50 [Can$3,322.30 to $45,503.50], P = 0.06). After discharge, harvest site-related complications occurred more frequently in the OVH group (27% vs 4.4%, P < 0.001), resulting in increased use of antibiotics (2.2% vs 0.8%, P = 0.02) as well as more frequent requirement for home nursing assistance in the OVH group (5.7% vs 0.8%, P = 0.002) at 6 months of follow-up. Conclusions: Cumulative costs did not show a statistical difference between OVH and EVH, with higher intraoperative costs for EVH being offset by higher harvest site management costs in the OVH group.

Endoscopic radial artery harvesting procedure for coronary artery bypass grafting

Development and adoption of endoscopic minimally invasive saphenous vein harvesting prompted its application to the radial artery in an effort to minimize surgical trauma. Recently, we reported that endoscopic radial artery harvesting was associated with better wound appearance and it proved to be safe and effective, with less pain and fewer wound complications than the open surgical technique. Based on this positive experience, our institution adopted endoscopic radial artery harvesting, hence the aim of this manuscript is to describe the minimally invasive endoscopic radial artery harvesting for coronary artery bypass grafting.

Endoscopic versus open radial artery harvesting for coronary artery bypass grafting

BACKGROUND AND AIM OF THE STUDY

The radial artery has become the artery of choice after both internal thoracic arteries for coronary artery bypass grafting (CABG). This study compares wound healing and arm complications after endoscopic versus open radial artery harvesting.

METHODS

From January 2002 to July 2004, 509 patients underwent CABG including a radial artery conduit. Thirty-nine had endoscopic and 470 conventional open radial artery harvesting. A propensity score was used to obtain 1:3 matching of all endoscopic to 117 open-harvesting patients. Postoperative wound healing, local neurologic deficits, wound infection, and pain scores were compared.

RESULTS

Wound healing: 34 of 39 endoscopic wounds exhibited a perfect Hollander score versus 339 of 470 open-harvest wounds (p = 0.01). Wound appearance was better for endoscopic harvesting (p = 0.004). Three incomplete neurologic deficits were observed after open harvesting versus one complete neurologic deficit after endoscopic harvesting that recovered prior to hospital discharge. Incidence of wound infection was similar in both groups (p = 0.7), although infection was more severe with open harvesting. Pain score was lower (p = 0.006) with endoscopic harvesting.

CONCLUSIONS

Endoscopic radial artery harvesting was associated with better wound appearance and less pain. Occurrence of neurologic deficits and wound infection was infrequent in both groups.

Endoscopic radial artery harvesting

As novel technologies became available in the surgical scenario, there has been an increasing interest towards minimally invasive approaches for conduits harvesting in recent years. There is a consistent evidence in literature demonstrating the advantages of an endoscopic approach for saphenous vein harvesting over the open technique; therefore, several authors previously investigated and demonstrated the safety and usefulness also of an endoscopic approach for radial artery harvesting when compared to the open one. This article describes the currently available approaches for minimally invasive endoscopic radial artery harvesting (ERAH) and focuses on the authors' experience combining a reusable retractor and a disposable vessel sealing systems.