EARLY RESULTS OF THORACOSCOPIC INTERNAL MAMMARY ARTERY HARVEST USING AN ULTRASONIC SCALPEL

Objective: We developed a thoracoscopic internal mammary artery harves t technique using an ultrasonic scalpel, the Harmonic Scalpel (Ethicon Endo-Surgery, Cincinnati, OH). This is the first report of 9 month fo llow-up using this technique. Methods: The Harmonic Scalpel is activat ed ultrasonically by vibrating at 55 000 Hz. Compared with electrocaut ery, lower heat (<100 degrees C) and less smoke are generated. Thoraco scopic harvest using the Harmonic Scalpel with a book blade was perfor med for 48 internal mammary arteries (42 left, six right) in 46 patien ts. Four (8.7%) of them were redo cases. The left internal mammary to left anterior descending artery and the right internal mammary to righ t coronary artery anastomoses were accomplished on the beating heart. Two left internal mammary arteries were sequentially, anastomosed to d iagonal branches. Graft flow velocity was evaluated with pulsatile wav e color Doppler test on the second or third postoperative day and repe ated 3 and 6 months later. Results: The mean harvest time was 65 min ( range 35-95 min) for the left internal mammary artery and 37 min (rang e 25-45 min) for the right internal mammary artery. One left internal mammary artery was lost due to intimal dissection. The Harmonic Scalpe l-related morbidity was transient left phrenic palsy in one case and m ild heat injury at the skin incision in the majority of cases. One Pat ient (2.2%) expired due to ischemic bowel on the second postoperative day. At a mean of 9 months follow-up, 45 alive patients have been free of angina. Doppler studies revealed diastolic augmentation of the gra ft how velocity in 22 left and two right internal mammary arteries on the second or third postoperative day and 23 left and five right inter nal mammary arteries 3 and 6 months after operation. Conclusions: Thor acoscopic internal, mammary artery harvest is feasible and facilitated by the use of the Harmonic Scalpel. Early results of this technique a re encouraging. (C) 1998 Elsevier Science B.V. All rights reserved.