Endoscopic versus open radial artery harvesting for coronary artery bypass grafting: an updated systematic review, meta-analysis, and GRADE assessment.

BACKGROUND

Endoscopic radial artery harvesting (ERAH) is a minimally invasive alternative to open radial artery harvesting (ORAH) for coronary artery bypass grafting (CABG), though concerns persist regarding graft patency and neurological outcomes.

METHODS

PubMed, Embase, Cochrane Library, and ClinicalTrials.gov were searched through February 21, 2026. Randomized controlled trials and propensity-matched observational studies were included. Risk of bias was assessed using ROB 2 and the Newcastle-Ottawa Scale; certainty of evidence was evaluated using GRADE. Pooled risk ratios and mean differences with 95% confidence intervals were calculated using a random-effects model.

RESULTS

ERAH significantly reduced wound complications (RR = 0.61, 95% CI: 0.39-0.96) and wound infections (RR = 0.57, 95% CI: 0.35-0.93), though this benefit did not persist in RCT-only analysis. Neurological complications were reduced after sensitivity analysis (RR = 0.44, 95% CI: 0.34-0.57). Graft patency was comparable (RR = 1.01, 95% CI: 0.90-1.14), with no significant differences in mortality, MACCE, or myocardial infarction. Observational data showed modest reductions in cardiopulmonary bypass time and hospital stay.

CONCLUSIONS

ERAH demonstrates comparable graft patency and major clinical outcomes to ORAH. Donor-site benefits suggested by observational studies are not consistently supported by randomized evidence. Large trials with standardized outcomes and long-term follow-up are needed.

TRIAL REGISTRATION: PROSPERO, CRD420261334767.