Endoscopic radial artery harvesting using a new “direct heat” dissector in an all-comers clinical setup
Serap Alkaya, Arnaud Van Linden, Mani Arsalan, Florian Hecker, Mirko Doss, Josepha Köhne, Thomas Walther.
Kerckhoff Klinik, Bad Nauheim, Germany.
OBJECTIVE: Common endoscopic graft harvesting devices, based on ultrasound or bipolar cautery, take advantage of the surrounding tissue for heat application. In comparison, the MiFusion TLS2 system (Endotrust, Germany) applies a “tissue-welding” technique for direct tissue sealing and graft preservation. The device is used in an open non-sealed CO2 insufflating setup.
METHODS: We retrospectively analyzed the data of 337 consecutive all-comer patients who underwent endoscopic radial artery (RA) harvesting using the MiFusion TLS2 system for coronary artery bypass grafting (CABG) between August 2014 and August 2015. Endoscopic RA harvesting is our standard graft harvesting technique and all surgeons learn this technique since the beginning of their surgical training. There is no age-limit and no general exclusion of emergency procedures. An Allen test ≤ 12 seconds is required for RA use.
RESULTS: Mean age was 67±10 years with 81% male patients. Median body mass index was 28.6 kg/m2 and 37% had diabetes mellitus. 85% were isolated CABG procedures and 60% of the RA grafts were used to bypass the circumflex territory. 14.3% of the patients had myocardial infarction within 30 days prior surgery and 4% were emergency procedures. Median RA harvesting time was 30 minutes. There was no graft injury due to harvesting technique. Thirty-day mortality was 0.8% for all patients and the median length of stay was 8 days. No RA harvesting associated wound healing complications occurred and there were no neurological arm complications. Two patients (0.6%) required surgical removal of hematoma.
CONCLUSIONS: Endoscopic RA harvesting using the MiFusion TLS2 system is safe, demonstrates excellent graft results and can be easily used in an all-comer daily routine.
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