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Ann Thorac Surg 2005;80:934-938
© 2005 The Society of Thoracic Surgeons

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Original article: Cardiovascular

Harmonic Scalpel Reduces Bleeding and Postoperative Complications in Redo Cardiac Surgery

^a Department of Cardiovascular Medicine, Division of Cardiac Surgery, Catholic University, Rome, Italy
^b Department of Cardiovascular Sciences, Units of Cardiac Surgery, University Campus Bio-Medico of Rome, Rome, Italy

Accepted for publication January 17, 2005.

^_* Address reprint requests to Dr Anselmi, Department of Cardiovascular Sciences, Unit of Cardiac Surgery, Campus Bio-Medico University of Rome, Via Longoni 83, 00155 Rome, Italy (Email: amedeo.anselmi{at}aliceposta.it).

BACKGROUND: Intraoperative and postoperative bleeding and injuries to cardiac structures are among the main determinants of complications and hospital and intensive care unit stay after cardiac reinterventions. The harmonic scalpel has been reported to achieve optimal tissue dissection with little blood loss. The present retrospective work was performed to evaluate the safety and usefulness of this device in redo cardiac surgery.

METHODS: Ninety-six redo cardiac surgery patients were operated on with the use of harmonic scalpel, and 105 redo patients operated on by traditional electrocautery and scissors were selected from our database and served as controls. Intraoperative and postoperative data of the two groups were collected and compared. Univariate and multiple logistic regression analyses were performed for identification of factors associated with death and with major and minor complications in the overall study population and in both groups, separately.

RESULTS: Although mortality and major postoperative morbidity were comparable in the two groups, harmonic scalpel patients presented markedly reduced postoperative bleeding, lower incidence of minor complications, cardiac injuries, major arrhythmias, and need for transfusions. Operative time and mean intensive care unit stay were shorter. Use of ultrascissor was found to be a protective factor against minor morbidity at multivariate analysis.

CONCLUSIONS: Our data suggest that harmonic scalpel is safe and is associated with better in-hospital outcome and lower postoperative blood loss in redo cardiac surgery.

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