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Ultrasonic scalpel versus electrocautery for internal mammary artery harvesting: a meta-analysis

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Abstract

Objective

Although an ultrasonic harmonic scalpel (HS) has been used to harvest the internal mammary artery (IMA) for coronary artery bypass grafting, the benefits and risks compared to conventional electrocautery (EC) are not clear. We aimed to compare the outcomes of HS versus EC for IMA harvesting.

Methods

An electronic search was performed to identify all relevant studies. Baseline characteristics, perioperative variables, and clinical outcomes were extracted and pooled for meta-analysis.

Results

This meta-analysis included 12 studies. Pooled analyses demonstrated that both groups had comparable preoperative baseline characteristics including age, gender, and left ventricular ejection fraction. HS included more diabetic patients [33% (95% CI 30, 35) vs. 27% (23, 31), p = 0.01]. Harvest time for unilateral IMA was significantly longer with HS than EC [39 (31, 47) minutes vs. 25 (17, 33) minutes, p < 0.01]. However, the rate of pedicled unilateral IMA was significantly higher for EC compared with HS [20% (17, 24) vs. 8% (7, 9), p < 0.01]. The rate of intact endothelium was significantly higher with HS than EC [95% (88, 98) vs. 81% (68, 89), p < 0.01). There was no significant difference in postoperative outcomes including bleeding [3% (2, 4)], sternal infection [3% (2, 4)], and operative/30-day mortality [3% (2, 4)].

Conclusions

HS required longer IMA harvest times which could be partially attributed to a higher skeletonization rate in this category. HS may cause less endothelial injury than EC; however, no significant differences in postoperative outcomes were seen between the groups.

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References

  1. Lawton JS, Tamis-Holland JE, Bangalore S, et al. 2021 ACC/AHA/SCAI guideline for coronary artery revascularization: executive summary: a report of the American college of cardiology/American heart association joint committee on clinical practice guidelines. Circulation. 2022;145(3):e4–17. https://doi.org/10.1161/CIR.0000000000001039.

    Article  PubMed  Google Scholar 

  2. Iddawela S, Mellor SL, Zahra SA, Khare Y, Harky A. Pedicled or skeletonized bilateral internal mammary artery harvesting - a meta- analysis and trial sequential analysis. Expert Rev Cardiovasc Ther. 2021;19(7):647–54. https://doi.org/10.1080/14779072.2021.1939684.

    Article  CAS  PubMed  Google Scholar 

  3. Wolf R. Early results of thoracoscopic internal mammary artery harvest using an ultrasonic scalpel. Eur J Cardiothorac Surg. 1998;14:54–7. https://doi.org/10.1016/S1010-7940(98)00105-5.

    Article  Google Scholar 

  4. Brose S, Fabricius AM, Falk V, Autschbach R, Weidenbach H, Mohr FW. Comparison of ultrasonic scalpel versus argon-beam and conventional electrocautery for internal thoracic artery dissection. Thorac Cardiovasc Surg. 2002;50(2):71–3. https://doi.org/10.1055/s-2002-26703.

    Article  CAS  PubMed  Google Scholar 

  5. Lima Lima PP. Endothelium histological integrity after skeletonized dissection of the left internal mammary artery with ultrasonic scalpel. Interact Cardiovasc Thorac Surg. 2005;4(3):160–2. https://doi.org/10.1510/icvts.2004.104828.

    Article  Google Scholar 

  6. Pektok E, Cikirikcioglu M, Engin C, Daglioz G, Ozcan Z, Posacioglu H. Does harvesting of an internal thoracic artery with an ultrasonic scalpel have an effect on sternal perfusion? J Thorac Cardiovasc Surg. 2007;134(2):442–7. https://doi.org/10.1016/j.jtcvs.2007.01.079.

    Article  PubMed  Google Scholar 

  7. El Shahawy HF, Badawy A, El Rahman HA, El Henawi AS, Azab S, Mostafa EA. Pathological changes by the effect of ultrasonic and electrocautery harvesting procedures on the internal thoracic artery endothelium. J Egypt Soc Cardiothorac Surg. 2005;13(3–4):42–8.

    Google Scholar 

  8. Bhan A, Choudhary SK, Saikia M, Sharma R, Venugopal P. Harmonic scalpel: initial experience. Asian Cardiovasc Thorac Ann. 2001;9(1):3–6. https://doi.org/10.1177/021849230100900102.

    Article  Google Scholar 

  9. Uyar İS, Kahraman D, Keskin G, Khalil E. Ultrastructural investigations of arterial bypass conduits after the use of different harvesting techniques using an electron microscope. Heart Surg Forum. 2020;23(1):E070–5. https://doi.org/10.1532/hsf.2657.

    Article  PubMed  Google Scholar 

  10. Kieser TM, Rose MS, Aluthman U, Narine K. Quicker yet safe: skeletonization of 1640 internal mammary arteries with harmonic technology in 965 patients. Eur J Cardiothorac Surg. 2014;45(5):e142–50. https://doi.org/10.1093/ejcts/ezu024.

    Article  PubMed  Google Scholar 

  11. Ohtsuka T, Wolf RK, Hiratzka LF, Wurnig P, Flege JB. Thoracoscopic internal mammary artery harvest for MICABG using the harmonic scalpel. Ann Thorac Surg. 1997;63(6):S107–9. https://doi.org/10.1016/S0003-4975(97)00292-0.

    Article  CAS  PubMed  Google Scholar 

  12. Onan B, Yeniterzi M, Onan IS, et al. Effect of electrocautery on endothelial integrity of the internal thoracic artery: ultrastructural analysis with transmission electron microscopy. Tex Heart Inst J. 2014;41(5):484–90. https://doi.org/10.14503/THIJ-13-3658.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Orejola WC, Villacin AB, Defilippi VJ, Mekhjian HA. Internal mammary artery harvesting using the harmonic scalpel. ASAIO J. 2000;46(1):99–102. https://doi.org/10.1097/00002480-200001000-00023.

    Article  CAS  PubMed  Google Scholar 

  14. Higami T, Yamashita T, Nohara H, Iwahashi K, Shida T, Ogawa K. Early results of coronary grafting using ultrasonically skeletonized internal thoracic arteries. Ann Thorac Surg. 2001;71(4):1224–8. https://doi.org/10.1016/S0003-4975(00)02660-6.

    Article  CAS  PubMed  Google Scholar 

  15. Taggart DP, Benedetto U, Gerry S, et al. Bilateral versus single internal-thoracic-artery grafts at 10 years. N Engl J Med. 2019;380(5):437–46. https://doi.org/10.1056/NEJMoa1808783.

    Article  PubMed  Google Scholar 

  16. McCarus SD. Physiologic mechanism of the ultrasonically activated scalpel. J Am Assoc Gynecol Laparosc. 1996;3(4):601–8. https://doi.org/10.1016/s1074-3804(05)80174-4.

    Article  CAS  PubMed  Google Scholar 

  17. Sutton PA, Awad S, Perkins AC, Lobo DN. Comparison of lateral thermal spread using monopolar and bipolar diathermy, the harmonic scalpel and the ligasure. Br J Surg. 2010;97(3):428–33. https://doi.org/10.1002/bjs.6901.

    Article  CAS  PubMed  Google Scholar 

  18. Kusu-Orkar TE, Kermali M, Masharani K, et al. Skeletonized or pedicled harvesting of left internal mammary artery: a systematic review and meta-analysis. Semin Thorac Cardiovasc Surg. 2021;33(1):10–8. https://doi.org/10.1053/j.semtcvs.2020.09.010.

    Article  PubMed  Google Scholar 

  19. Mazur P, Litwinowicz R, Tchantchaleishvili V, et al. Left internal mammary artery skeletonization reduces bleeding-a randomized controlled trial. Ann Thorac Surg. 2021;112(3):794–801. https://doi.org/10.1016/j.athoracsur.2020.10.024.

    Article  PubMed  Google Scholar 

  20. Lamy A, Browne A, Sheth T, et al. Skeletonized vs pedicled internal mammary artery graft harvesting in coronary artery bypass surgery: a post hoc analysis from the COMPASS trial. JAMA Cardiol. 2021;6(9):1042–9. https://doi.org/10.1001/jamacardio.2021.1686.

    Article  PubMed  Google Scholar 

  21. Gaudino M, Audisio K, Rahouma M, et al. Comparison of long-term clinical outcomes of skeletonized vs pedicled internal thoracic artery harvesting techniques in the arterial revascularization trial. JAMA Cardiol. 2021;6(12):1380–6. https://doi.org/10.1001/jamacardio.2021.3866.

    Article  PubMed  Google Scholar 

  22. Cunningham JM, Gharavi MA, Fardin R, Meek RA. Considerations in the skeletonization technique of internal thoracic artery dissection. Ann Thorac Surg. 1992;54(5):947–50. https://doi.org/10.1016/0003-4975(92)90656-o.

    Article  CAS  PubMed  Google Scholar 

  23. Higami T, Maruo A, Yamashita T, Shida T, Ogawa K. Histologic and physiologic evaluation of skeletonized internal thoracic artery harvesting with an ultrasonic scalpel. J Thorac Cardiovasc Surg. 2000;120(6):1142–7. https://doi.org/10.1067/mtc.2000.110189.

    Article  CAS  PubMed  Google Scholar 

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This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Division of Cardiac Surgery, Department of Surgery, Thomas Jefferson University, 1025 Walnut St, Suite 607, Philadelphia, PA, 19107, USA

    Daisuke Kaneyuki, Sanath Patil, Julian Jackson, Danial Ahmad, Konstadinos A. Plestis, Thomas S. Guy, Howard T. Massey, John W. Entwistle, Rohinton J. Morris & Vakhtang Tchantchaleishvili

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  1. Daisuke Kaneyuki
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  2. Sanath Patil
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  3. Julian Jackson
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Correspondence to Vakhtang Tchantchaleishvili.

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Kaneyuki, D., Patil, S., Jackson, J. et al. Ultrasonic scalpel versus electrocautery for internal mammary artery harvesting: a meta-analysis. Gen Thorac Cardiovasc Surg 71, 723–729 (2023). https://doi.org/10.1007/s11748-023-01943-6

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