Endoscopic Radial Artery Harvesting Through a Single Incision

Randomized Trial of 2 Endoscopic Radial Artery Harvesting Devices-Immunofluorescence Assessment

BACKGROUND

Various devices are available for endoscopic radial artery harvesting during coronary artery bypass grafting. Thermal spread and graft damage, however, are common concerns. The aim of this study was to compare the MiFusion TLS2 system (Endotrust, Nettetal Germany) with direct heat technique and the LigaSure Maryland system (Medtronic, Dublin, Ireland) using advanced bipolar technique in a prospective randomized study.

METHODS

One hundred consecutive patients undergoing coronary artery bypass grafting with endoscopic radial artery harvesting were prospectively included and randomized 1:1. The proximal (brachial) ends of the grafts were analyzed using fluorescence microscopy with focus on graft integrity. In addition, harvesting time, graft sealing, residual bleeding, and incidence of neurological disorders were compared.

RESULTS

Patient age was 67 ± 8 years. Mean harvesting time was 26.5 ± 9 minutes for the TLS2 and 23.2 ± 8 minutes for the LigaSure (P = .049). Overall graft integrity was good in both groups. A significantly better graft integrity was observed in the LigaSure group (scale 0 to 3; 3 = best) with 2.5 ± 0.6 for TLS2 and 2.8 ± 0.4 for LigaSure (P = .031). LigaSure provided significantly better graft sealing (scale 0 to 2; 0 = best) with 0.6 ± 0.7 vs 1.0 ± 0.6 (TLS2) (P = .006) and less residual bleeding (scale 1 to 5; 1 = best) with 1.4 ± 0.6 vs 2.0 ± 0.9 (TLS2) (P < .001). Transient sensibility disorders were less frequently observed with LigaSure (2% vs 16%, P = .015).

CONCLUSIONS

Endoscopic radial artery harvesting can be performed with excellent results and good graft integrity using both devices. Compared with the MiFusion TLS2, the LigaSure device led to faster procedural times and resulted in better graft integrity. Along with providing a better seal, LigaSure was associated with less sensibility disorders.

Dissection of both frontal and parietal branches of the superficial temporal artery for bypass surgery through a single linear skin incision

BACKGROUND

Double superficial temporal artery (STA) to middle cerebral artery (MCA) bypass surgery has typically involved more than one linear incision. In this report, we demonstrate how the procedure can be performed through a single linear skin incision over the parietal branch of the STA.

METHODS

Initial dissection of the parietal branch and creation of a subcutaneous cavity along the frontal branch were performed using the conventional microscopic method. Detailed additional dissection and isolation of the frontal branch were accomplished with the aid of an endoscopic retractor.

RESULTS

This procedure was performed in five patients for harvesting of approximately 8- and 5-cm lengths of the parietal and frontal branches, respectively. The resultant lengths of the harvested vessels were sufficient for anastomotic revascularization of MCA recipient arteries in both the frontal and temporal lobes.

CONCLUSION

This method can be safely performed with achievement of a less invasive dissection of the STA and an overall improved cosmetic outcome.

Patency rates of endoscopically harvested radial arteries one year after coronary artery bypass grafting

OBJECTIVES

To improve patients' acceptance of the radial artery as a graft for coronary revascularization, we introduced an endoscopic harvesting technique. The aim of this study was to assess graft quality 1 year after the operation.

METHODS

In 50 patients who underwent endoscopic radial artery harvesting for coronary artery bypass grafting, 64-slice computed tomography, electrocardiography, and echocardiography were utilized to assess graft patency and left ventricle function at a 1-year follow-up. In addition, the influencing factors of radial artery graft patency were evaluated. Radial artery patency was compared with a control group from our database.

RESULTS

Any patency of endoscopically harvested radial artery grafts was 78% (39/50) and perfect patency was 72% (36/50) 1 year after coronary revascularization. The implanting surgeon and graft harvester, patient factors, graft properties, medication, and target territory did not influence the patency rates of the radial artery graft. The only significant and strong parameter to predict perfect graft patency was the severity of the target vessel stenosis (P < .001). In patients with a target vessel stenosis of 90% or greater, radial artery graft patency was 90.3% (28/31). Patency rates of endoscopically (72%) and conventionally (74%) harvested radial arteries were not different (P = .822).

CONCLUSIONS

Patency rates 1 year after endoscopic radial artery harvesting are comparable to the open technique. On the basis of our results, we attempt to use the radial artery as a bypass graft only for target coronary arteries with 90% or greater stenosis. We recommend endoscopic harvesting as the technique of choice to harvest the radial artery.