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J Thorac Cardiovasc Surg 1995;110:504-510
© 1995 Mosby, Inc.

SURGERY FOR ACQUIRED HEART DISEASE

COMPARISON OF THE EFFECT OF MONOPOLAR AND BIPOLAR CAUTERIZATION ON SKELETONIZED, DISSECTED INTERNAL THORACIC ARTERIES

Seattle, Wash.

From The Hope Heart Institute, the Providence Medical Center, and the Department of Surgery, University of Washington School of Medicine, Seattle, Wash.

Received for publication Sept. 2, 1994. Accepted for publication Dec. 28, 1994. Address for reprints: Lester R. Sauvage, MD, 528 18th Ave., Seattle, WA 98122.

Abstract

The internal thoracic artery is preferable to the saphenous vein for use as a conduit for coronary artery bypass. More extensive use is possible if this artery is mobilized in a skeletonized form to provide greater length. Internal thoracic arteries are usually mobilized with cauterization. This study compared the effectiveness and effects on neighboring areas of division of the branches of the canine internal thoracic artery with bipolar cauterization and monopolar cauterization. Branch closure was significantly more secure in the bipolar cauterization group, with bleeding in 25 (9%) of 279 branches of 15 internal thoracic arteries treated with monopolar cauterization, in contrast to bleeding in 4 (1.3%) of 306 branches in the 15 internal thoracic arteries treated with bipolar cauterization, which were paired with the group treated with monopolar cauterization. The group of internal thoracic arteries treated with monopolar cauterization had a significantly higher prevalence of leakage when luminal pressure was increased from 120 to 160 mm Hg. Scanning electron microscopy demonstrated partial loss of endothelial cells on the flow surface of internal thoracic arteries treated with bipolar cauterization, compared with almost complete loss of endothelial cells around the orificial areas after monopolar cauterization. Secondary bipolar cauterization treatment caused only slightly more damage than primary treatment, but secondary monopolar cauterization was much more severe and extensive than primary treatment. These data suggest that bipolar cauterization is preferable to monopolar cauterization for skeletonized dissection of the internal thoracic artery. (J THORAC CARDIOVASC SURG 1995;110:504-10)

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