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J Thorac Cardiovasc Surg 2001;122:624-626
© 2001 The American Association for Thoracic Surgery
Brief Communications |
From the Faculty of Medicine, Department of Cardiovascular Surgery,a Faculty of Pharmacy, Department of Pharmacology,b and Faculty of Medicine, Department of Medical Biology,c Ege University, Bornova, Izmir, Turkey
Received for publication Aug 30, 2000. Accepted for publication March 9, 2001. Address for reprints: Mustafa Çikirikçioglu, MD, Trakya Üniversitesi Tip Fakültesi, Kalp Damar Cerrahisi Anabilim Dali, 22030 Edirne, Turkey (E-mail: mustafacoglu{at}trakya.edu.tr).
Many reports have shown the advantage of using the Harmonic Scalpel (Ethicon Endo-Surgery, Inc, Cincinnati, Ohio) during radial artery harvesting. It provides safe, fast, spasm free, and less traumatic radial artery harvest without a need for hemostatic clips.
1,2
In the present study, we compared the effects of two harvesting techniques, Harmonic Scalpel versus electrocautery, on the vasoreactivity and endothelial integrity of the radial artery.
Materials and methods
This study was performed on discarded human radial artery segments collected from patients (n = 14) undergoing coronary artery bypass grafting at Ege University, Medical Faculty, Department of Cardiovascular Surgery. Patients with diabetes mellitus, history of smoking, hyperlipidemia, cerebrovascular disease, peripheral vascular disease, and age older than 65 years were excluded from the study because these factors might have affected endothelial function. Consent for the study was obtained from all patients. All patients were given only nitrates preoperatively.
Radial artery harvesting was performed by the same surgeon (M.C.) for standardization of the technique. Patients were randomly divided into two groups whose demographic characteristics were similar.
In the first group, radial arteries were harvested by means of an ultrasonic scalpel (Ultracision Harmonic Scalpel, 5-mm blunt hook blade dissector-DH085, level III). Surgical clips were applied only to major collateral branches when necessary. In the second group, electrocautery with low energy (Aspen Sabre Electrosurgical Unit, Con Med, Englewood, Colo, 30 W) was used to separate the radial artery from the subcutaneous tissue, muscle, and overlying fascia. The collateral branches were occluded by means of hemostatic clips (Ethicon Endo-Surgery; Ligaclip LT200). Additionally, all patients received intravenous diltiazem at a dose of 1µg · kg–1 · min–1 as a result of the limitations of patient safety and practical and ethical regulations. The radial artery was covered with a warm sponge soaked in papaverine and diltiazem to avoid spasm. Distal anastomosis was performed by means of a standard technique. The required length was carefully measured before proximal anastomosis. After measurement, discarded segments of the radial artery were immediately collected and placed into a container with oxygenated physiologic salt solution (Krebs) maintained at 4°C and then immediately (within 5-10 minutes) transferred to the pharmacology laboratory. The specific time periods between harvesting and testing procedures were in the range of 45 to 70 minutes.
Vascular reactivity of the rings cut from discarded segments was investigated in the organ baths. 3 Cumulative concentration-response curves to acetylcholine, nitroglycerin, phenylephrine, and 5-hydroxytryptamine were constructed in each preparation. The means of maximum responses (Emax) and geometric means of the 50% effective concentration (EC50) values (pD2) were compared. The endothelial integrity of the radial artery was examined by scanning electron microscopy.
Data analysis
Values of Emax and EC50 were derived for each cumulative concentration-response curve with an iterative nonlinear curve fitting (KaleidaGraph 3.06; Synergy Software, Reading, Pa). Means of the negative logarithm of EC50 values (pD2) were compared. The Student t test for unpaired data was used.
Results
The Emax and pD2 values of 5-hydroxytryptamine–induced and phenylephrine-induced contractions and acetylcholine-induced and nitroglycerin-induced relaxations did not yield any statistically significant difference between the groups (Table 1).
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4,5 However, the possibility that harvesting techniques may influence the vasoreactivity of the radial artery has not been tested. Therefore, the aim of the present study is to investigate the vasoreactivity of the radial artery, harvested by means of the Harmonic Scalpel in comparison with electrocautery, and to investigate possible effects of these techniques on endothelial integrity. Considering the influence of harvesting technique on the vasoreactivity of radial artery, the results of the present study show that radial arteries harvested either by the Harmonic Scalpel or by electrocautery do not differ in their response to various vasoconstrictor and vasodilator agonists. The Harmonic Scalpel does not affect the contractile properties and endothelium-dependent or -independent relaxations of the radial arteries of the patients undergoing coronary bypass grafting as compared with rings harvested by electrocautery.
As the present findings regarding the two harvesting techniques resulted from in vitro organ bath experiments, further studies will be necessary to demonstrate whether they have any effect on the clinical condition, such as long-term patency, of patients undergoing bypass surgery.
Acknowledgments
We gratefully acknowledge Dr B. Hakan Sen from Ege University Faculty of Dentistry for technical supportive work on scanning electron microscopy.
References
This article has been cited by other articles:
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S. Bleiziffer, I. Hettich, B. Eisenhauer, D. Ruzicka, M. Wottke, J. Hausleiter, S. Martinoff, M. Morgenstern, and R. Lange Patency rates of endoscopically harvested radial arteries one year after coronary artery bypass grafting J. Thorac. Cardiovasc. Surg., September 1, 2007; 134(3): 649 - 656. [Abstract] [Full Text] [PDF]
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