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J Thorac Cardiovasc Surg 2007;134:442-447
© 2007 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Does harvesting of an internal thoracic artery with an ultrasonic scalpel have an effect on sternal perfusion?

^a Service for Cardiovascular Surgery, University of Geneva, Geneva, Switzerland
^b Department of Cardiovascular Surgery, Ege University, Bornova-Izmir, Turkey
^c Department of Nuclear Medicine, Ege University, Bornova-Izmir, Turkey.

Received for publication November 9, 2006; revisions received January 24, 2007; accepted for publication January 29, 2007.

^_* Address for reprints: Erman Pektok, MD, Hôpitaux Universitaire de Genève, Service de Chirurgie Cardiovasculaire, Rue Micheli-du-Crest 24, CH-1211 Genève 14, Switzerland. (Email: epektok{at}hotmail.com).

Objectives: Despite many animal and clinical studies to date, there is still debate on the effect of internal thoracic artery harvesting on postoperative sternal perfusion and thus healing. We performed a prospective clinical study to assess the postoperative sternal perfusion in patients who underwent surgical coronary revascularization by means of unilateral internal thoracic artery harvesting and to evaluate the effect of 2 harvesting methods, namely electrocautery and use of an ultrasonic scalpel.

Methods: Between November 2004 and March 2005, 30 consecutive patients (25 male patients; age, 58.34 ± 9.42 years; mean New York Heart Association class, 1.90 ± 0.76) scheduled for conventional coronary surgery were enrolled in this study. After obtaining informed consent, they were randomized into 2 groups. The left internal thoracic artery was harvested as a pedicle graft in all patients by using the corresponding method. All patients underwent 99mTc–methylene diphosphonate bone scintigraphy preoperatively to evaluate baseline sternal perfusion. Control scintigraphy was performed on postoperative day 7.

Results: Sternal perfusion showed a significant increase on postoperative scans compared with that at baseline (1067 ± 191 counts/pixel vs 919 ± 102 counts/pixel for the right half, P < .001; 1064 ± 179 counts/pixel vs 905 ± 107 counts/pixel for the left half, P < .001). There was no significant difference between the right and left sternal halves postoperatively. The method used for harvest had no significant effect on postoperative sternal perfusion (electrocautery = 1037 ± 121 counts/pixel vs scalpel = 1097 ± 109 counts/pixel for the right half, P > .05; electrocautery = 1040 ± 126 counts/pixel vs scalpel = 1089 ± 130 counts/pixel for the left half, P > .05).

Conclusions: Sternal perfusion increases soon after coronary bypass surgery, probably as a consequence of the healing process, but the source of perfusion for harvest side remains unclear. Harvesting of internal thoracic arteries with an ultrasonic scalpel has no advantageous effects on postoperative sternal perfusion.

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