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

Mitral valve replacement with preservation of valve leaflets and chordae tendineae

Forty patients with chronic mitral valve disease underwent mitral valve replacement [MVR] at the National Heart Institute, Imbaba in a prospective study to compare between MVR with and without preservation of valve leaflets and chordae tendineae, to study the influence of preservation of parts of the MV apparatus on immediate and early postoperative course of left ventricualr [LV] function. The patients [pts] have been divided into two groups: group I [20 pts] had MVR with preservation of the MV apparatus while group II [20 pats] had conventional MVR. Preoperative, operative and postoperative data are reviewed for both groups with follow up for 6 months. Patients of group l showed easier weaning off bypass, shorter stay in ICU and hospital, and better preservation of IV function early postoperatively when compared to patients of group II. We conclude that MVR with preservation of the MV apparatus is more economic to patient and hospital, and decreases morbidity and mortality duo to better preservation of LV function postoperatively