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Harmonic scalpel reduces bleeding and postoperative complications in redo cardiac surgery
Nicola Luciani1, Amedeo Anselmi, Mario Gaudino
1Division of Cardiac Surgery, Department of Cardiovascular Medicine, Catholic University, Rome, Italy.
Insights
The harmonic scalpel demonstrates safety and improved outcomes in redo cardiac surgery, significantly reducing postoperative bleeding and complications compared to traditional methods.
Area of Science:
- Cardiovascular Surgery
- Surgical Technology
Background:
- Bleeding and cardiac structure injuries are key complications in redo cardiac surgery.
- The harmonic scalpel offers precise tissue dissection with minimal blood loss.
- Evaluating the harmonic scalpel's efficacy in repeat cardiac procedures is crucial.
Purpose of the Study:
- To assess the safety and utility of the harmonic scalpel in redo cardiac surgery.
- To compare outcomes between harmonic scalpel use and traditional electrocautery.
Main Methods:
- Retrospective analysis of 96 redo cardiac surgery patients using harmonic scalpel versus 105 controls using electrocautery.
- Comparison of intraoperative and postoperative data, including bleeding, complications, and hospital stay.
- Logistic regression analysis to identify factors associated with adverse outcomes.
Main Results:
- Harmonic scalpel group showed significantly reduced postoperative bleeding, minor complications, cardiac injuries, and transfusion needs.
- Operative time and intensive care unit stay were shorter in the harmonic scalpel group.
- Mortality and major morbidity were similar between groups; ultrascissor use was protective against minor morbidity.
Conclusions:
- The harmonic scalpel is a safe and effective device for redo cardiac surgery.
- It is associated with improved in-hospital outcomes and reduced blood loss.
- This technology may enhance patient recovery in complex cardiac reinterventions.
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.
