PDF(Pubmed)
Abstract：
UNASSIGNED: 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).
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: The utilization of shear-tip Harmonic scalpel for IMA harvesting in MICABG is feasible and yields stable early results.
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: The utilization of shear-tip Harmonic scalpel for IMA harvesting in MICABG is feasible and yields stable early results.
摘要：
■乳内动脉（IMA）是冠状动脉旁路移植术（CABG）中最常用的移植物，因为它具有优越的长期通畅率。然而,它的小直径带来了处理方面的挑战，在手术期间可能发生的任何血管损伤都会显著影响手术结果。IMA采集期间的主要重点是确保安全和有效的止血，而不会直接损伤血管。同时确保血管分支的安全可靠结扎。使用多个外科器械的各种方法已经用于此目的。与传统乐器不同,剪切尖端谐波手术刀提供更精确的血管分支控制，同时尽量减少对周围组织的损害。在这项研究中,我们评估了剪切尖端谐波手术刀在微创冠状动脉旁路移植术(MICABG)患者中的应用价值.
■从2019年4月到2023年5月，共有40名患者接受了MICABG。IMA是使用剪切尖端谐波手术刀和无夹骨架技术采集的。在这个队列中，5例患者接受了完整的内窥镜采集，而34例患者通过最小开胸手术进行了直接可视化采集。通过测量旁路导管中的多普勒流量计来评估移植物通畅性。
■所有患者均获得了成功的移植物通畅。IMA收获的平均持续时间为87分钟。总的来说,40名患者中有38名在不需要体外循环的情况下接受了MICABG，确保程序稳定。在任何患者中均未观察到移植物相关事件或并发症，都出院了，没有任何问题。在15.2个月的中位随访期间，只有一名患者经历了需要干预的移植物闭塞。
■在MICABG中使用剪切尖端谐波手术刀进行IMA采集是可行的，并产生稳定的早期结果。
■从2019年4月到2023年5月，共有40名患者接受了MICABG。IMA是使用剪切尖端谐波手术刀和无夹骨架技术采集的。在这个队列中，5例患者接受了完整的内窥镜采集，而34例患者通过最小开胸手术进行了直接可视化采集。通过测量旁路导管中的多普勒流量计来评估移植物通畅性。
■所有患者均获得了成功的移植物通畅。IMA收获的平均持续时间为87分钟。总的来说,40名患者中有38名在不需要体外循环的情况下接受了MICABG，确保程序稳定。在任何患者中均未观察到移植物相关事件或并发症，都出院了，没有任何问题。在15.2个月的中位随访期间，只有一名患者经历了需要干预的移植物闭塞。
■在MICABG中使用剪切尖端谐波手术刀进行IMA采集是可行的，并产生稳定的早期结果。
