Ultrasonic aspiration in coronary artery surgery

Ultrasonic Devices in Cardiac Surgery

Recent innovations in ultrasonic devices include high-frequency coagulating shears with piezoelectric ceramic electrostrictive transducers for both open and endoscopic procedures. Various ultrasonic devices have been used for the dissection of internal mammary, radial, and gastroepiploic arteries, aortic root, proximal right coronary artery, and left main coronary artery, as well as prior to surgical coronary ostial reconstruction and for elimination of stenotic induration in coronary arteries, release of muscle bridges, exposure of deep-seated coronary arteries, pericardiectomy, and removal of a cardiac tumor. Unlike valve decalcification, the required energy output of ultrasonic aspirators in coronary artery surgery is much lower and harvesting time of arterial conduits is significantly shortened. Ultrastructural studies of harvested internal mammary artery segments with scanning and transmission electron microscopy revealed no structural alteration of the wall or luminal surface when low energy output was used for dissection. On direct application of higher energy, subendothelial blistering may be detected occasionally. Ultrasonic devices help to remove thick fatty tissue and muscle bridges with almost no bleeding. Use of these devices may facilitate precise coronary artery surgery.

Use of an ultrasonic surgical aspirator to expose buried coronary arteries

In coronary artery bypass grafting, the target arteries for grafting can be buried in thick adipose tissue or myocardium, and exposure may be difficult. We used an ultrasonic surgical aspirator to expose buried coronary arteries. Fat tissue or myocardium covering coronary arteries was removed, and target arteries were exposed with little bleeding. No arrhythmia or coronary spastic event occurred during its application, and bypass grafting could be completed. In postoperative angiography, no deformity or shrinkage of coronary arteries was observed at the sites at which the ultrasonic aspirator was applied.

Application of ultrasonic aspirator for dissection of the internal mammary artery in coronary artery bypass grafting

The low-power ultrasonic aspirator was used for the dissection of the internal mammary artery (IMA) in 20 patients undergoing coronary artery bypass grafting. Harvesting time was shorter and the amount of bleeding was less than with the ordinary method. The short-term patency rate (1 to 6 months) for those IMA grafts was 95% (19 of 20 remained patent). These results have encouraged us to use the ultrasonic aspirator routinely for IMA dissection.