The harmonic scalpel: optimizing the quality of mammary artery bypass grafts

Background. The damage done to the endothelium during the preparation of a graft used in an aortocoronary procedure is a risk factor for early graft failure. We compared the effect on the endothelium of the mammary arteries when the harvest was done either by the harmonic scalpel (HS) or the high-frequency electrocauter (HF). Methods. Twenty-four mammary arteries were harvested and divided into two groups depending on the use of the HS or the HF. The endothelial damage was analyzed with a scanning electron microscope. The groups were compared in regard to the size of the internal mammary artery (IMA) pedicle. Results. The endothelial damage of the IMAs taken down with the HS was significantly less than when taken down with the HF if the IMA pedicle size was less than 0.5 cm. Conclusions. The HS has a positive effect on the endothelial preservation, especially when the preparation is done closely to the IMA. The HS is profitable in minimally invasive procedures, particularly when it is difficult to keep a wide enough distance from the IMA.