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Ultrastructural Investigations of Arterial Bypass Conduits after the Use of Different Harvesting Techniques Using an
İhsan Sami Uyar1, Dogan Kahraman2, Gökhan Keskin3
1Department of Cardiothoracic Surgery, Ahi Evren University, Kirsehir, Turkey.
Insights
The harmonic scalpel technique for harvesting arterial conduits in coronary artery bypass grafting (CABG) significantly reduces pathological findings compared to electrocautery. This method shows promise in decreasing graft occlusion and endothelial dysfunction.
Area of Science:
- Cardiovascular Surgery
- Vascular Biology
- Surgical Techniques
Background:
- Coronary artery bypass grafting (CABG) relies on the quality of arterial conduits.
- Traditional harvesting methods can cause endothelial damage, impacting graft patency.
- Minimizing conduit injury is crucial for long-term graft survival.
Purpose of the Study:
- To compare the morphometric and histopathologic outcomes of arterial conduits harvested using a harmonic scalpel versus traditional electrocautery.
- To evaluate the impact of harvesting technique on conduit integrity and potential for graft dysfunction.
Main Methods:
- A comparative study involving 100 CABG patients, with 200 arterial conduits (100 radial arteries and 100 left internal thoracic arteries) harvested.
- Conduits were harvested using either a harmonic scalpel (Group 1) or low-voltage electrocautery (Group 2).
- Histopathologic analysis using transmission electron microscopy assessed endothelial integrity, subendothelial damage, and other pathologies. Harvesting time and blood flow were also measured.
Main Results:
- The harmonic scalpel group showed significantly fewer pathological findings (10%) compared to the electrocautery group (32%) (P = .001).
- Radial artery harvesting time was significantly shorter with the harmonic scalpel (20.3 min vs. 27.6 min, P = .022).
- Left internal thoracic artery harvesting time was similar between groups, and blood flow was comparable for both conduit types and harvesting methods.
Conclusions:
- The harmonic scalpel technique results in less histopathologic damage to arterial conduits used in CABG.
- Despite a potential learning curve, this technique may reduce the incidence of graft occlusion, thrombus formation, and endothelial dysfunction.
- The harmonic scalpel represents a promising alternative for arterial conduit harvesting in CABG surgery.
Objectives:
The aim of this study was to perform morphometric analysis of arterial conduits harvested by harmonic scalpel in coronary artery bypass grafting (CABG) patients.
Methods:
From 100 CABG patients, 200 arterial conduits-100 radial arteries (RAs) and 100 left internal thoracic artery (LITAs)-were harvested. The patients had similar characteristics (mean age, sex ratio, comorbidities, etc.). We divided the patients into 2 groups according to harvesting technique. In group 1, a harmonic scalpel was used in 50 patients for harvesting arterial conduits (50 LITA and 50 RA). In group 2, conduits were harvested using low-voltage electrocautery. To prevent side effects of clipping, all conduits in both groups remained in perfused condition until anastomosis. A 10-mm length of conduit was cut for transmission electron microscopy investigation. We calculated duration of harvesting, blood flow changes, and histopathologic changes of the conduits according to a vessel scoring system.
Results:
In the harmonic scalpel group, we detected pathologic findings-corruption of endothelial integrity, subendothelial damage, and endothelial pathology-in 5 specimens (10%) (3 LITA [6%] and 2 RA [4%]). In group 2, pathologic findings were detected in 16 conduits (32%; 11 LITA, 22%, and 5 RA, 10%). Endothelial dissection, subendothelial disarrangement, cellular separation due to intercellular edema, and subadventitial hematoma were the main pathologic changes in the classic harvesting method. There was a significant difference between the groups (P = .001). Harvesting time of LITA was nearly similar in both groups: 26.9 ± 11.1 min (range 25-38) in group 1 and 21.3 ± 8.6 min (range 21-25) in group 2 (P = .049). RA harvesting time was significantly shorter with the harmonic scalpel technique (20.3 ± 3.9 versus 27.6 ± 5.4 min, P = .022). The blood flow of the conduits was similar, with no statistical difference for the 2 arterial conduits (LITA, P = .76; RA, P = .55).
Conclusion:
In the learning curve period, the use of a harmonic scalpel is time consuming and presents some difficulties during the harvesting of conduits. According to our study results, however, the harmonic scalpel technique may be useful because of decreased pathology, including spasm. In our opinion, graft occlusion or thrombus as a life-threatening condition and endothelial dysfunction may decrease with the use of this alternative harvesting technique.
