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Randomized comparison of ultrasonic aspiration versus conventional electrocautery for dissection of the human
Insights
Ultrasonic aspirator use during internal thoracic artery harvesting for coronary artery bypass grafting shows reduced vessel trauma compared to conventional electrocautery. This method preserves arterial function and improves responses to certain vasodilators.
Area of Science:
- Cardiovascular Surgery
- Vascular Biology
- Surgical Techniques
Background:
- Conventional electrocautery is the standard for internal thoracic artery (ITA) harvesting in coronary artery bypass grafting (CABG).
- Potential for vessel damage exists with conventional electrocautery, impacting graft patency and function.
- Alternative harvesting techniques are being explored to minimize ITA trauma.
Purpose of the Study:
- To compare the efficacy and safety of ultrasonic aspirator-assisted ITA harvesting versus conventional electrocautery.
- To evaluate the functional integrity of ITA segments harvested using different methods.
- To assess the impact of harvesting techniques on vascular reactivity.
Main Methods:
- Patients were randomized into six groups: conventional electrocautery, ultrasonic aspirator (60%, 80%, 100% power), and ultrasonic aspirator (100% CAVI-Pulse modes 1 and 3).
- Harvested ITA ring segments were subjected to organ bath studies to assess contractile responses (potassium chloride, noradrenaline) and relaxation responses (acetylcholine, bradykinin, sodium nitroprusside).
Main Results:
- Conventional electrocautery resulted in 40% of vessels failing to respond to contractile stimuli due to trauma.
- Ultrasonic aspirator groups showed significantly reduced failure rates (10% at 60-100% power, 0% in CAVI-Pulse mode 1).
- Ultrasonic aspirator use enhanced contractile responses and improved bradykinin-mediated relaxation compared to conventional methods.
Conclusions:
- Ultrasonic aspirator-assisted ITA harvesting, especially at 100% power and CAVI-Pulse mode 1, minimizes vessel damage and preserves vascular function.
- This technique offers a promising alternative to conventional electrocautery for CABG, potentially improving graft outcomes.
- Further clinical studies are warranted to confirm the long-term benefits of this improved harvesting technique.
Abstract:
The most common technique currently employed to harvest the internal thoracic artery for coronary artery bypass grafting is conventional electrocautery. This study compared an alternative method, electrocautery with an ultrasonic aspirator, for harvesting the internal thoracic artery. Patients were randomly assigned to one of six experimental groups (conventional electrocautery, ultrasonic aspirator at settings of 60%, 80%, and 100% power output, and ultrasonic aspirator in 100% CAVI-Pulse modes 1 and 3). Ring segments of internal thoracic artery were studied in an organ bath. Contraction responses were elicited with 123 mmol/L potassium physiologic salt solution, KPSS, KPSS solution containing noradrenaline, and a cumulative noradrenaline dose-contraction curve. Relaxation studies were performed with the vasodilators acetylcholine, bradykinin, and sodium nitroprusside. Forty percent of the electrocauterized vessels were traumatized or damaged and failed to respond to contractile stimuli, whereas only 10% of the vessels in ultrasonic aspirator groups 60%, 80%, and 100% failed to respond. All vessels in the group harvested by ultrasonic aspirator in 100% CAVI-Pulse mode 1 responded, whereas 20% of the vessels in the group harvested by ultrasonic aspirator in 100% CAVI-Pulse mode 3 failed to respond. All settings of electrocautery with an ultrasonic aspirator produced a greater contractile response to KPSS and noradrenaline. Acetylcholine and sodium nitroprusside produced similar relaxations in all groups, but the bradykinin responses were significantly improved in all groups undergoing 100% electrocautery with an ultrasonic aspirator. These results suggest that 100% electrocautery with an ultrasonic aspirator, particularly in 100% CAVI-Pulse mode 1, resulted in less damage and trauma than conventional electrocautery during harvesting of the internal thoracic artery.