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Original Articles: Adult Cardiac

Optical Coherence Tomography Imaging as a Quality Assurance Tool for Evaluating Endoscopic Harvest of the Radial Artery

^a Department of Surgery, University of Maryland, Baltimore, Maryland
^b Department of Information Systems, University of Maryland, Baltimore, Maryland
^c St. Michael’s Medical Center, Newark, New Jersey

Accepted for publication December 10, 2007.

^_* Address correspondence to Dr Poston, University of Maryland School of Medicine, 22 S Greene St, Ste N4W94, Baltimore, MD 21201 (Email: rposton{at}smail.umaryland.edu).

Presented at the Basic Science Forum of the Fifty-fourth Annual Meeting of the Southern Thoracic Surgical Association, Bonita Springs, FL, Nov 7–10, 2007.

Background: Concerns about intimal disruption and spasm have limited enthusiasm for endoscopic radial artery harvest (ERAH), although the risk of these problems after this procedure remains uncertain. Radial artery conduits were screened intraoperatively before and after ERAH vs open harvest using catheter-based high-resolution optical coherence tomography (OCT) imaging.

Methods: Twenty-four cadavers and 60 coronary artery bypass graft (CABG) patients scheduled to receive a RA graft underwent OCT imaging before (in situ) and after (ex vivo) open harvest or ERAH. Spasm was quantified by the percentage change in luminal volume between images. Intimal disruption was classified as minor or severe depending on whether the defect was confined to branch ostia or involved the luminal surface. Histology was used to confirm OCT findings.

Results: Luminal volume significantly declined after harvest in all RAs from CABG patients, but there was no difference between groups: –43% ± 29% vs –35% ± 38% change after ERAH (n = 21) vs open harvest (n = 39; p = 0.342). Significantly more intimal injury was noted after ERAH vs open harvest (34/41 vs 9/43, intimal tears/total evaluated RAs, p < 0.0001). Most intimal injury was minor: only 2 tears involved the luminal surface of the RA (both after ERAH). Serial imaging in cadavers revealed that 86% of ostial tears occur in ERAH during the initial blunt dissection step using the endoscope.

Conclusions: Although branch injury is a pitfall of ERAH, OCT imaging documented that the quality of RA procured is acceptable and comparable with open harvest. Catheter-based OCT provides an important quality assurance tool for RA harvest.

This article has been cited by other articles:

				P. S. Brazio, P. C. Laird, C. Xu, J. Gu, N. S. Burris, E. N. Brown, Z. N. Kon, and R. S. Poston Harmonic scalpel versus electrocautery for harvest of radial artery conduits: Reduced risk of spasm and intimal injury on optical coherence tomography. J. Thorac. Cardiovasc. Surg., November 1, 2008; 136(5): 1302 - 1308. [Abstract] [Full Text] [PDF]