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Ann Thorac Surg 2000;69:1833-1835
© 2000 The Society of Thoracic Surgeons

Original articles: Cardiovascular

The harmonic scalpel: optimizing the quality of mammary artery bypass grafts

Peter Lamm, MDa, Gerd Juchem, MDb, Peter Weyrich, MDc, Albert Schütz, MDa, Bruno Reichart, MDa

a Department of Cardiac Surgery, University Hospital Großhadern, Ludwig-Maximilians-Universität München, München, Germany
b Department of Anesthesiology, University Hospital Großhadern, Ludwig-Maximilians-Universität München, München, Germany
c Department of Cardiology, University Hospital Grosshadern, Ludwig-Maximilians-Universität München, München, Germany

Address reprint requests to Dr Lamm, Department of Cardiac Surgery Universität München am Augustinum, Wolkerweg 16, 81375 München, Germany
e-mail: lamm{at}lrz.uni-muenchen.de

Background. The damage done to the endothelium during the preparation of a graft used in an aortocoronary procedure is a risk factor for early graft failure. We compared the effect on the endothelium of the mammary arteries when the harvest was done either by the harmonic scalpel (HS) or the high-frequency electrocauter (HF).

Methods. Twenty-four mammary arteries were harvested and divided into two groups depending on the use of the HS or the HF. The endothelial damage was analyzed with a scanning electron microscope. The groups were compared in regard to the size of the internal mammary artery (IMA) pedicle.

Results. The endothelial damage of the IMAs taken down with the HS was significantly less than when taken down with the HF if the IMA pedicle size was less than 0.5 cm.

Conclusions. The HS has a positive effect on the endothelial preservation, especially when the preparation is done closely to the IMA. The HS is profitable in minimally invasive procedures, particularly when it is difficult to keep a wide enough distance from the IMA.




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