Ultrasonic scalpel versus electrocautery for internal mammary artery harvesting: a meta-analysis.
Coronary artery bypass grafting
Electrocautery
Internal mammary artery
Ultrasonic harmonic scalpel
Journal
General thoracic and cardiovascular surgery
ISSN: 1863-6713
Titre abrégé: Gen Thorac Cardiovasc Surg
Pays: Japan
ID NLM: 101303952
Informations de publication
Date de publication:
Dec 2023
Dec 2023
Historique:
received:
20
01
2023
accepted:
15
05
2023
medline:
21
11
2023
pubmed:
13
6
2023
entrez:
13
6
2023
Statut:
ppublish
Résumé
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. An electronic search was performed to identify all relevant studies. Baseline characteristics, perioperative variables, and clinical outcomes were extracted and pooled for meta-analysis. 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)]. 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.
Identifiants
pubmed: 37310563
doi: 10.1007/s11748-023-01943-6
pii: 10.1007/s11748-023-01943-6
doi:
Types de publication
Meta-Analysis
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
723-729Informations de copyright
© 2023. The Author(s), under exclusive licence to The Japanese Association for Thoracic Surgery.
Références
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 .
doi: 10.1161/CIR.0000000000001039
pubmed: 34882436
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 .
doi: 10.1080/14779072.2021.1939684
pubmed: 34092171
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 .
doi: 10.1016/S1010-7940(98)00105-5
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 .
doi: 10.1055/s-2002-26703
pubmed: 11981704
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 .
doi: 10.1510/icvts.2004.104828
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 .
doi: 10.1016/j.jtcvs.2007.01.079
pubmed: 17662787
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.
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 .
doi: 10.1177/021849230100900102
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 .
doi: 10.1532/hsf.2657
pubmed: 32118547
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 .
doi: 10.1093/ejcts/ezu024
pubmed: 24574446
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 .
doi: 10.1016/S0003-4975(97)00292-0
pubmed: 9203612
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 .
doi: 10.14503/THIJ-13-3658
pubmed: 25425979
pmcid: 4189348
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 .
doi: 10.1097/00002480-200001000-00023
pubmed: 10667725
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 .
doi: 10.1016/S0003-4975(00)02660-6
pubmed: 11308164
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 .
doi: 10.1056/NEJMoa1808783
pubmed: 30699314
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 .
doi: 10.1016/s1074-3804(05)80174-4
pubmed: 9050696
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 .
doi: 10.1002/bjs.6901
pubmed: 20101674
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 .
doi: 10.1053/j.semtcvs.2020.09.010
pubmed: 32979482
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 .
doi: 10.1016/j.athoracsur.2020.10.024
pubmed: 33171172
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 .
doi: 10.1001/jamacardio.2021.1686
pubmed: 34132753
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 .
doi: 10.1001/jamacardio.2021.3866
pubmed: 34586338
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 .
doi: 10.1016/0003-4975(92)90656-o
pubmed: 1417291
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 .
doi: 10.1067/mtc.2000.110189
pubmed: 11088039