Harvest or not to harvest: A step-wise decision for radial artery graft selection in surgical coronary revascularisation

Vascular assessment of the radial artery morphology and physiology plays a key role in addressing its suitability for coronary artery bypass grafting. Our objective was to generate a new scale supporting the structured evaluation of radial artery quality. A multicentre, three-round e-Delphi and advisory committee were employed to develop and undertake preliminary content validation of our Radial Artery Quality Evaluation Survey, recruiting 22 clinical experts, consisting of Surgical Care Practitioners and Consultant Cardiac Surgeons. Delphi response rates were 88%, 93% and 100% across rounds 1-3, respectively, with 80% participation from the advisory committee. Research outcomes were to determine the level of agreement on the quality indicators, stability of consensus and final selection of quality indicators. Iterative consensus building established inclusion of 14 quality indicators across six assessment domains: surgical accessibility, inspection of radial artery morphology, detection of pathological abnormalities, visualisation of pulsatile and blood flows and quality of harvesting. Eligibility criteria were agreement ⩾ 75%, interquartile range ⩽ 1 and median ⩾ 4. A numerical rating scale was validated by the advisory committee for impartial monitoring of radial artery quality. The Radial Artery Quality Evaluation Survey provides a structured framework for the evaluation and selection of radial artery grafts in surgical coronary revascularisation, supporting a standardised approach to radial artery assessment.