Ultrasonic scalpel versus electrocautery for internal mammary artery harvesting: a meta-analysis.

Authors

• Daisuke Kaneyuki
• Sanath Patil
• Julian Jackson
• Danial Ahmad
• Konstadinos A Plestis
• Thomas S Guy
• Howard T Massey
• John W Entwistle
• Rohinton J Morris
• Vakhtang Tchantchaleishvili

Publication/Presentation Date

12-1-2023

Abstract

OBJECTIVE: Although an ultrasonic harmonic scalpel (HS) has been used to harvest the internal mammary artery (IMA) for coronary artery bypass grafting, the benefits and risks compared to conventional electrocautery (EC) are not clear. We aimed to compare the outcomes of HS versus EC for IMA harvesting.

METHODS: An electronic search was performed to identify all relevant studies. Baseline characteristics, perioperative variables, and clinical outcomes were extracted and pooled for meta-analysis.

RESULTS: This meta-analysis included 12 studies. Pooled analyses demonstrated that both groups had comparable preoperative baseline characteristics including age, gender, and left ventricular ejection fraction. HS included more diabetic patients [33% (95% CI 30, 35) vs. 27% (23, 31), p = 0.01]. Harvest time for unilateral IMA was significantly longer with HS than EC [39 (31, 47) minutes vs. 25 (17, 33) minutes, p <  0.01]. However, the rate of pedicled unilateral IMA was significantly higher for EC compared with HS [20% (17, 24) vs. 8% (7, 9), p <  0.01]. The rate of intact endothelium was significantly higher with HS than EC [95% (88, 98) vs. 81% (68, 89), p <  0.01). There was no significant difference in postoperative outcomes including bleeding [3% (2, 4)], sternal infection [3% (2, 4)], and operative/30-day mortality [3% (2, 4)].

CONCLUSIONS: HS required longer IMA harvest times which could be partially attributed to a higher skeletonization rate in this category. HS may cause less endothelial injury than EC; however, no significant differences in postoperative outcomes were seen between the groups.

Volume

71

Issue

12

First Page

723

Last Page

729

ISSN

1863-6713

Published In/Presented At

Kaneyuki, D., Patil, S., Jackson, J., Ahmad, D., Plestis, K. A., Guy, T. S., Massey, H. T., Entwistle, J. W., Morris, R. J., & Tchantchaleishvili, V. (2023). Ultrasonic scalpel versus electrocautery for internal mammary artery harvesting: a meta-analysis. General thoracic and cardiovascular surgery, 71(12), 723–729. https://doi.org/10.1007/s11748-023-01943-6

Disciplines

Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods

PubMedID

37310563

Department(s)

Administration and Leadership

Document Type

Article