Early results of thoracoscopic internal mammary artery harvest using an ultrasonic scalpel.

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Abstract
Objective: We developed a thoracoscopic internal mammary artery harvest technique using an ultrasonic scalpel, the Harmonic Scalpel (Ethicon Endo-Surgery, Cincinnati, OH). This is the first report of 9 month follow-up using this technique. Methods: The Harmonic Scalpel is activated ultrasonically by vibrating at 55 000 Hz. Compared with electrocautery, lower heat (≪100°C) and less smoke are generated. Thoracoscopic harvest using the Harmonic Scalpel with a hook blade was performed for 48 internal mammary arteries (42 left, six right) in 46 patients. Four (8.7%) of them were redo cases. The left internal mammary to left anterior descending artery and the right internal mammary to right coronary artery anastomoses were accomplished on the beating heart. Two left internal mammary arteries were sequentially, anastomosed to diagonal branches. Graft flow velocity was evaluated with pulsatile wave color Doppler test on the second or third postoperative day and repeated 3 and 6 months later. Results: The mean harvest time was 65 min (range 35–95 min) for the left internal mammary artery and 37 min (range 25–45 min) for the right internal mammary artery. One left internal mammary artery was lost due to intimal dissection. The Harmonic Scalpel-related morbidity was transient left phrenic palsy in one case and mild heat injury at the skin incision in the majority of cases. One Patient (2.2%) expired due to ischemic bowel on the second postoperative day. At a mean of 9 months follow-up, 45 alive patients have been free of angina. Doppler studies revealed diastolic augmentation of the graft flow velocity in 22 left and two right internal mammary arteries on the second or third postoperative day and 23 left and five right internal mammary arteries 3 and 6 months after operation. Conclusions: Thoracoscopic internal mammary artery harvest is feasible and facilitated by the use of the Harmonic Scalpel. Early results of this technique are encouraging.

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