Endoscopic Radial Artery Harvest Improves Hand Function in CABG Patients: NEJM

A new study published in The New England Journal of Medicine showed that endoscopic radial artery harvesting results in fewer neurologic impairments and small gains in patient-reported hand function among patients after coronary artery bypass surgery when compared to the open harvesting procedure.

The two primary methods for radial artery harvesting in coronary artery bypass grafting are endoscopic and open procedures. Endoscopic harvesting is linked to smaller incisions, less wound problems, and better patient comfort, but the open technique provides direct visualization and technical ease.

To balance graft quality, surgical effectiveness, and postoperative results in coronary artery bypass graft (CABG) patients, it is crucial to compare these methods. In order to evaluate the effectiveness of endoscopic or open radial artery harvest in coronary artery bypass surgery, this study was carried out.

In people slated for coronary artery bypass surgery, investigators compared endoscopic radial artery harvest with open radial artery harvest in a randomized controlled experiment. The main outcome was patient-reported hand function three months after random assignment, as measured by the Hand Function Questionnaire (scores range from 5 to 49, with lower scores pointing to more favorable outcomes; a minimal clinically significant difference has not been definitively established but may be roughly 3 points). Neurologic impairments were among the secondary outcomes.

A total of 300 patients were randomized to either open radial artery harvest (149 patients) or endoscopic radial artery harvest (151 patients). The patients allocated to endoscopic radial artery harvest scored 7.20 points on the Hand Function Questionnaire at 3 months, while patients assigned to open radial artery harvest scored 7.74 points (difference, 0.52 points; 95% confidence interval [CI], 0.06 to 0.98; P=0.03).

When compared to 82 of 149 (55.0%) patients in the open radial artery harvest group, 32 of 151 (21.2%) patients in the endoscopic radial artery harvest group experienced neurologic impairments (relative risk with open radial artery harvest, 2.61; 95% CI, 1.90 to 3.63). When compared to 4 of 149 (2.7%) patients in the open radial artery harvest group, 9 of 151 (6.0%) patients in the endoscopic radial artery harvest group experienced one or more major adverse events (relative risk with open radial artery harvest, 0.45; 95% CI, 0.13 to 1.34).

Overall, when compared to open radial artery harvest, endoscopic radial artery harvest resulted in somewhat improved patient-reported hand function and was linked to fewer neurologic impairments in patients scheduled for coronary artery bypass surgery.

Source:

Carranza, C. L., Petersen, J. J., Ballegaard, M., Werner, M. U., Hasbak, P., Kjaer, A., Kofoed, K. F., Lindschou, J., Gluud, C., Olsen, M. H., Engstrøm, J., & Jakobsen, J. C. (2026). Endoscopic or open radial artery harvest in coronary artery bypass surgery. NEJM Evidence, 5(1). https://doi.org/10.1056/EVIDoa2500199