Harmonic scalpel: a word of caution

Harmonic Scalpel: Initial Experience

A Harmonic Scalpel was used to harvest arterial conduits in 80 patients undergoing coronary bypass grafting (group 1). Another 80 patients had electrocautery (group 2). Off-pump beating heart coronary grafting was performed in 24 patients in group 1 and 18 in group 2; these patients underwent coronary angiography. Moderately hypothermic cardiopulmonary bypass was used in all others. There were 134 arterial conduits (78 left internal mammary arteries, 14 right internal mammary arteries, and 42 radial arteries) in group 1, and 141 arterial conduits (80 left internal mammary arteries, 11 right internal mammary arteries, and 50 radial arteries) in group 2. The number of hemoclips used, postoperative blood loss, and homologous blood product requirements were significantly less in group 1. One patient in group 1 and 3 in group 2 required reoperation for excessive bleeding. Postoperative angiograms in 24 patients in group 1 (37 arterial conduits) revealed 100% graft patency. In group 2, 1 of 18 patients who had angiography showed marked narrowing of the left internal mammary artery in the distal third, attributable to electrocautery injury. The Harmonic Scalpel was a useful, safe, and probably superior alternative to electrocautery for arterial harvesting.