harmonic scalpel: Optimizing the quality of radial artery bypass grafts

Development of new antispasmodic agents and minimally traumatic techniques has led to a revival of the use of Radial Artery [RA] in coronary artery bypass surgery. The ultrasonic activated scalpel [Harmonic Scalpel] has been increasingly used in harvesting arterial conduits. We began to use it for RA harvest with the impression that harvest spasm might be less for the new technique In a prospective randomized study, the harmonic scalpel is used to harvest the RA [group H; 21 patients] in comparison with conventional technique using the electrocautery [group C; 20 patients]. Both groups are compared for the harvest time, frequency of spasm, use of hemoclips, free blood flow [immediately after harvesting and after use of topical vasodilator] and incidence for reoperation for bleeding. The use of harmonic scalpel significantly reduced the harvest time, and the need for hemoclips. It also increased significantly the free blood flow from the conduit. It reduced the incidence of spasm [but without statistical significance]. The incidence of reoperation for bleeding was not significantly different between both techniques. Ultrasonic dissection using the harmonic scalpel provides atraumatic, fast, spasm-free RA harvest with minimal use of hemoclips. Long-term patency rates, however, need to be evaluated

Transmyocardial laser revascularization [TMR]; is a novel option of patients having advanced ischemic heart disease with intractable angina and poor left ventricular function

TMR is a successful treatment for chronic refractory angina in patients having diffuse CAD, not amenable to PTCA or CABG and exhausted drug therapy, but still having normal or nearly normal left ventricular [L.V.] function However in our practice in Egypt, we have to perform TMR for patients having severely diffuse CAD with poor L.V. function. This study was done to determine the clinical outcome of TMR for patients having end stage CAD and poor L.V. function Out of one hundred patients had CAD not amenable to PTCA or CABG underwent sole TMR with a CO2 laser [the heart laser system P.L.C. medical system]. Twenty five patients had a high score of medical therapy with preoperative special anesthetics management and using of GIK intravenous infusion as a metabolic support for the myocardium in addition to long term postoperative rehabilitation program. The results showed that, there was no operative or postoperative mortality and considerable early post operative morbidity. Follow up of the patients up to 12 month showed [1] reduction of 2 or 3 angina classes as compared with preoperative state. [2] improvement exercise tolerance. [3] decreased of Cardio- active medication. [4] improvement of myocardial perfusion of the lazed areas. It was concluded that the, TMR has emerged as an effcient treatment for patients with interctable angina and low ejection fraction