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Surgeon. 2014 Oct;12(5):249-55. doi: 10.1016/j.surge.2013.09.005. Epub 2013 Oct 23.

Comparison of thermal damage of the internal thoracic artery using ultra high radiofrequency and monopolar diathermy.

Author information

1
Department of Cardiac Surgery, Split University Hospital Centre and Split University School of Medicine, Spinčićeva 1, 21000 Split, Croatia. Electronic address: cristijan.bulat@zg.t-com.hr.
2
Department of Pathology, Split University Hospital Centre and Split University School of Medicine, Spinčićeva 1, 21000 Split, Croatia.
3
Department of Nuclear Medicine, Split University Hospital Centre and Split University School of Medicine, Spinčićeva 1, 21000 Split, Croatia.
4
Department of Cardiac Surgery, Split University Hospital Centre and Split University School of Medicine, Spinčićeva 1, 21000 Split, Croatia.
5
Department of Pediatric Surgery, Split University Hospital Centre and Split University School of Medicine, Spinčićeva 1, 21000 Split, Croatia.
6
Department of Surgery, Split University Hospital Centre and Split University School of Medicine, Spinčićeva 1, 21000 Split, Croatia.

Abstract

BACKGROUND:

The internal thoracic artery (ITA) has been accepted worldwide as a first choice conduit for myocardial revascularisation. It still remains questionable what is the best method for ITA harvesting in a skeletonized fashion according to structural integrity of artery, as a risk factor of early and late graft failure. The purpose of this study was to determine the impact of the ultra-high radiofrequency energy used for ITA harvesting on arterial structural integrity, in particular on the endothelial layer.

METHODS:

Seventy-four ITA specimens were divided into two groups depending on device used for harvesting (radiofrequency-knife (RF) or electrocauter (EC)). Thermal damage on arterial structural integrity was measured using light microscope, morphometric imaging analysis and immunohistochemical methods.

RESULTS:

Thermal damage of endothelium was 2.8 times higher in EC than in RF group (p = 0.041) and 5 times higher in patients older than 66 years of age (p = 0.002). Extent of endothelial damage (graded from 0 to 3) was significantly higher in EC group (p = 0.03). Also, in EC group, in patients older than 66 years of age higher proportion of extent of endothelial damage was found (p = 0.027).

CONCLUSIONS:

The endothelial damage was more often in EC than in RF group as in the patients older than 66 years of age. Demonstrated results suggest that the radiosurgery in comparison to conventional electrocautery is safe and effective method, and significantly reduces thermal damage to endothelial layer of artery.

KEYWORDS:

Internal thoracic artery; Radiosurgery; Skeletonization; Thermal damage

PMID:
24257459
DOI:
10.1016/j.surge.2013.09.005
[Indexed for MEDLINE]
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