J W Ronan1, L A Perry, H B Barner, T M Sundt. 1. Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri 63108, USA.
Abstract
BACKGROUND: The radial artery (RA) is used increasingly for myocardial revascularization. Having an ultrasonic dissector available in our unit, we began to use it for RA harvest with the impression that harvest spasm might be less for the new technique. METHODS: We compared RA harvest using standard techniques (21 RA) with ultrasonic dissection (41 RA) in which all branches were divided between clips with scissors in the former and bleeding branches were clipped in the latter. RESULTS: Harvest times were not different. Conventional technique used 74+/-18 (mean +/- standard deviation) clips versus 3.2+/-4.3 clips (p<0.001). In situ free flow was 17.2+/-20.7 mL/min for conventional technique versus 52.5+/-48.1 for ultrasonic (p<0.001). Free flow after the proximal anastomosis to the left internal thoracic artery was 38.5+/-60.4 mL/min for conventional technique and 50.7+/-29.6 for ultrasonic (p = 0.008). Free flow 10 minutes after intraluminal papaverine was 78.5+/-45.9 mL/min for usual technique versus 102.8+/-51.7 for ultrasonic (p = 0.016). No patient required reoperation for bleeding. CONCLUSIONS: Ultrasonic dissection of the RA is associated with decreased RA spasm, good hemostasis, no additional harvest time, and has become our standard technique.
BACKGROUND: The radial artery (RA) is used increasingly for myocardial revascularization. Having an ultrasonic dissector available in our unit, we began to use it for RA harvest with the impression that harvest spasm might be less for the new technique. METHODS: We compared RA harvest using standard techniques (21 RA) with ultrasonic dissection (41 RA) in which all branches were divided between clips with scissors in the former and bleeding branches were clipped in the latter. RESULTS: Harvest times were not different. Conventional technique used 74+/-18 (mean +/- standard deviation) clips versus 3.2+/-4.3 clips (p<0.001). In situ free flow was 17.2+/-20.7 mL/min for conventional technique versus 52.5+/-48.1 for ultrasonic (p<0.001). Free flow after the proximal anastomosis to the left internal thoracic artery was 38.5+/-60.4 mL/min for conventional technique and 50.7+/-29.6 for ultrasonic (p = 0.008). Free flow 10 minutes after intraluminal papaverine was 78.5+/-45.9 mL/min for usual technique versus 102.8+/-51.7 for ultrasonic (p = 0.016). No patient required reoperation for bleeding. CONCLUSIONS: Ultrasonic dissection of the RA is associated with decreased RA spasm, good hemostasis, no additional harvest time, and has become our standard technique.
Authors: Philip S Brazio; Patrick C Laird; Chenyang Xu; Junyan Gu; Nicholas S Burris; Emile N Brown; Zachary N Kon; Robert S Poston Journal: J Thorac Cardiovasc Surg Date: 2008-11 Impact factor: 5.209