International Society For Minimally Invasive Cardiothoracic Surgery

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Prospective Randomized Comparison Of Two Different Endoscopic Radial Artery Harvesting Devices
Arnaud Van Linden1, Florian Hecker1, Mani Arsalan2, Manfred Richter1, Brigitte Matzke3, Julius Beckers1, Tomas Holubec1, Serap Van Linden1, Thomas Walther2.
1Kerckhoff Klinik, Bad Nauheim, Germany, 2University Frankfurt, Frankfurt, Germany, 3Max-Planck Institut, Bad Nauheim, Germany.

Objectives: Endoscopic radial artery harvesting (ERAH) is clinical routine during coronary artery bypass grafting (CABG) using different devices with different energy sources. Thermal spread and potential graft damage are the most common concerns. Aim of this study was a prospectively randomized comparison of the MiFusion TLS2 system (Endotrust, Germany) with direct heat technique and the LigaSure Maryland system (Medtronic, USA) with advanced bipolar technique. Methods: 100 consecutive all-comer CABG patients undergoing ERAH were prospectively included and randomized 1:1 to either TLS2 or LigaSure. ERAH was performed in a standard non-sealed fashion. The proximal ends of the grafts were analyzed using immunfluoroscopic microscopy with focus on graft integrity. In addition harvesting time, graft sealing and subjective impression of freedom from blood in the harvesting situs were compared. Results: Mean age was 678 years with 14% female. Mean harvesting time was 26.59 minutes for the TLS2 and 23.28 minutes for the LigaSure (p=0.049). The endothelial graft integrity was comparable in both groups. There was a significantly better graft integrity in the internal elastical layer for LigaSure (scale 0 to 3; 3=best) with 2.50.6 for TLS2 and 2.80.4 for LigaSure (p=0.031). Graft sealing (scale 0 to 2; 0=best) and freedom from residual bleeding (scale 1 to 5; 1=best) was favorable for LigaSure with 0.60.7 vs. 1.00.6 (p=0.006) and 1.40.6 vs 2.00.9 (p<0.001). Conclusion: This study demonstrates excellent results for ERAH with generally good graft integrity (Figure 1) and quick and safe harvesting. In direct comparison, the LigaSure device is faster and results in better graft integrity in elastic interna, with better sealing.
LEGEND Figure 1: Example of a perfect integrity of radial artery in aSMA-CD31 immunfluoroscopic microscopy: Intima red, elastic interna blue, media green.


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