Endoscopic Radial Artery Harvest in Coronary Artery Bypass Surgery: Clinicopathological Evaluation

Objectives: The radial artery is used as a second arterial conduit in coronary artery bypass surgery. However, concerns exist about the thermal injury incurred to the radial artery during endoscopic harvest. We sought to assess this effect both histologically and radiologically. Methods: From February 2015 to March 2016, 50 consecutive patients undergoing coronary artery bypass surgery utilizing endoscopically harvested radial artery were prospectively studied. Computerized tomography coronary angiography scan was performed randomly in 8 patients who also had their respective radial artery analyzed histologically at the time of harvest. Standard coronary angiography was also performed in 4 additional patients driven by symptoms recurrence. Results: All patients were available for follow up at 1 year following the surgery. There was no mortality during follow-up. Three patients (6%) developed transient complications in the harvest arm which resolved. All radial arteries were patent on follow-up imaging. Histological examination showed integrity of the arterial wall, intact endothelial lining, patent lumens and no significant pathological abnormalities. Conclusion: The use of endoscopic radial artery harvest was associated with few self-limiting morbidities and excellent patency rates. In addition, there was no evidence of any thermal or traumatic injuries sustained to the radial arteries when examined histologically. The use of endoscopically harvested radial arteries appears safe with excellent results.

Thrombocytopenia Following Perceval Suture-Less Aortic Valve Implantation

Objectives: Thrombocytopenia has been reported following implantation of Perceval suture-less aortic valve. However, the time course of thrombocytopenia and platelet recovery is unknown. In addition, the effect of thrombocytopenia on post-operative outcome is unknown. We sought to study this observation and correlate that with short-term outcome. Methods: This is a retrospective review of a prospectively collected database over a 3-year period of all isolated aortic valve replacements (70 patients) using bioprosthetic valves (sutured Magna and suture-less Perceval). All preoperative, intraoperative and postoperative variables were collected and analyzed. Platelets count and mean platelet volumes were collected and analyzed in respect to the type of valve used and their time course. Results: The cohort consisted of 70 consecutive patients of which 42 underwent Perceval suture-less valve (group Perceval) and 28 underwent bioprosthetic sutured valve (group Magna). There was no difference in platelets count and mean platelet volume at baseline. However, Perceval group had significant drop in platelet count from day 1 to day 3 post-operatively, followed by a gradual increase in platelet count until discharge. Mean platelet volume, however, was not different between the two types of valves. Postoperative outcomes were similar in the two groups with exception of intensive care and a hospital stay which were significantly shorter in Perceval group. Conclusion: Thrombocytopenia following Perceval suture-less valve is observed from day 1 postoperatively and it is a transient phenomenon. It does not correlate with worse clinical outcomes postoperatively. Larger studies are needed to elucidate the mechanism and its impact.