Jung Yong Chae, Chong Yooyoung, Kang Min-Woong, Han Sung Joon, Cho Hyun Jin, Park Sang-Jun, Shim Man-Shik
Department of Thoracic and Cardiovascular Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea.
Department of Thoracic and Cardiovascular Surgery, Chungnam National University Sejong Hospital, Sejong-si, South Korea.
J Thorac Dis. 2024 Jun 30;16(6):3711-3721. doi: 10.21037/jtd-23-1810. Epub 2024 Jun 13.
The internal mammary artery (IMA) is the most commonly used graft in coronary artery bypass grafting (CABG) because of its superior long-term patency rate. However, its small diameter poses challenges in handling, and any vascular damage that may occur during harvesting can significantly affect surgical outcomes. The primary focus during IMA harvesting is to ensure safe and effective hemostasis without direct vascular injury, while ensuring secure and reliable ligation of the vascular branches. Various methods using multiple surgical instruments have been used for this purpose. Unlike traditional instruments, the shear-tip Harmonic scalpel offers more precise vessel branching control, while minimizing damage to surrounding tissues. In this study, we assessed the utility of the shear-tip Harmonic scalpel in patients undergoing minimally invasive coronary artery bypass grafting (MICABG).
From April 2019 to May 2023, a total of 40 patients underwent MICABG. The IMA was harvested using the shear-tip Harmonic scalpel with a clipless skeletonized technique. In this cohort, 5 patients underwent complete endoscopic harvesting, while 34 patients underwent direct visualization harvesting through minimal thoracotomy. Graft patency was assessed by measuring a Doppler flowmeter in the bypass conduit.
Successful graft patency was achieved in all patients. The mean duration of IMA harvesting was 87 min. In total, 38 of the 40 patients underwent MICABG without the need for cardiopulmonary bypass, ensuring a stable procedure. There were no graft-related events or complications observed in any of the patients, and all were discharged without any issues. During a median follow-up period of 15.2 months, only one patient experienced graft occlusion necessitating intervention.
The utilization of shear-tip Harmonic scalpel for IMA harvesting in MICABG is feasible and yields stable early results.
由于乳内动脉（IMA）具有较高的长期通畅率，它是冠状动脉旁路移植术（CABG）中最常用的移植物。然而，其管径较小给操作带来了挑战，并且在获取过程中可能发生的任何血管损伤都会显著影响手术结果。获取IMA时的主要重点是确保安全有效的止血，避免直接血管损伤，同时确保血管分支的牢固可靠结扎。为此已经使用了多种使用多种手术器械的方法。与传统器械不同，剪切头超声刀能更精确地控制血管分支，同时将对周围组织的损伤降至最低。在本研究中，我们评估了剪切头超声刀在接受微创冠状动脉旁路移植术（MICABG）患者中的效用。
2019年4月至2023年5月，共有40例患者接受了MICABG。使用剪切头超声刀采用无夹骨骼化技术获取IMA。在该队列中，5例患者进行了完全内镜下获取，而34例患者通过微创开胸进行直接可视化获取。通过测量旁路管道中的多普勒流量计评估移植物通畅情况。
所有患者均成功实现移植物通畅。IMA获取的平均持续时间为87分钟。40例患者中有38例在无需体外循环的情况下接受了MICABG，确保了手术过程的稳定性。所有患者均未观察到与移植物相关的事件或并发症，并且均顺利出院。在中位随访期15.2个月期间，只有1例患者发生移植物闭塞需要干预。
在MICABG中使用剪切头超声刀获取IMA是可行的，并能产生稳定的早期结果。
