Internal mammary artery (IMA) harvesting using the harmonic scalpel (HS) was recently introduced. We studied 541 IMAs harvested by the same surgeon through a standard median sternotomy in 472 coronary bypass patients; 252 (47%) with the HS, while 289 (53%) were with electrocautery (EC). Patient demographics included mean ages: 67 years HS vs. 65 years EC (p = NS); male:female ratio: 3:1; and insulin dependent diabetes mellitus (IDDM): 11% HS vs. 12.5% EC (NS). Mean ultrasonic IMA flow at a mean SBP of 70 mm Hg in 10 consecutive patients of each group were: preharvest, HS 11.9 +/- 2.3 ml/min vs. EC 8.5 +/- 1.6 ml/min (p = 0.256); postharvest, HS 35.7 +/- 10.7 ml/min vs. EC 22 +/- 2.9 ml/min (0.235); and postcardiopulmonary bypass (post-CPB), HS 47.8 +/- 6.2 ml/min vs. EC 41.7 +/- 2.5 ml/min (0.381). Histologic samples of 50 consecutive IMAs showed no evidence of vessel injury in either group. Clinical results revealed postoperative bleeding in 6/217 (2.7%) HS vs. 7/255 (2.7%) EC (p = 0.783), none attributed to bleeding from the IMA; phrenic paresis: 0/217 in HS but 1/255 (0.4%) in EC (p = 0.960); sternal wound infection: 5/217 (2.3%) HS vs. 6/255 (2.4%) EC (p = 0.787); postoperative IABP: 6/217 (2.7%) HS vs. 5/255 (2%) EC (p = 0.859); mortality: 2/217 (0.9%) HS vs. 2/255 (0.8%) EC (p = 0.710). Hemodynamic, histologic, and clinical results were comparable in both groups. The authors believe the HS is safe and effective for IMA harvesting.

+More

harmonic scalpel hs phrenic sbp ultrasonic ima flow mammary artery ima harvesting

W C, Orejola A B, Villacin V J, Defilippi H A, Mekhjian,.Internal mammary artery harvesting using the harmonic scalpel.. 46 (1),99-102.

W C, Orejola A B, Villacin V J, Defilippi H A, Mekhjian,"Internal mammary artery harvesting using the harmonic scalpel." 46

W C, Orejola A B, Villacin V J, Defilippi H A, Mekhjian,"Internal mammary artery harvesting using the harmonic scalpel."