Skeletonized Internal Mammary Artery Harvesting with Harmonic Ultrasonic Shears Versus Cold Dissection

Mohamed Serag; Mohamed Omar; Noha Helal

Mohamed Serag Department of Cardiothoracic Surgery, Faculty of Medicine, Beni-Suef University, Egypt
Mohamed Omar Department of Cardiothoracic Surgery, Faculty of Medicine, Benha University, Egypt
Noha Helal Department of Cardiothoracic Surgery, Faculty of Medicine, Benha University, Egypt

Keywords: Skeletonization, Harmonic ultrasonic shears, Cold dissection, Coronary artery bypass grafting, Graft Patency Severity Scale, Arterial revascularization

Abstract

Background: Skeletonized internal mammary artery (IMA) harvesting offers several advantages over pedicled techniques in coronary artery bypass grafting (CABG). The optimal dissection tool remains controversial. Harmonic ultrasonic shears may reduce endothelial and thermal injury while improving operative efficiency compared with conventional cold dissection. The study aimed to compare operative efficiency, safety, and early graft outcomes of skeletonized IMA harvesting using harmonic ultrasonic shears versus conventional cold dissection.

Methods: In this prospective randomized study, 200 patients undergoing elective isolated CABG were randomized to harmonic shear harvesting (HS group, n = 100) or cold dissection with scissors and clips (CD group, n = 100). Operative variables, postoperative outcomes, and graft patency at 6 months were analyzed.

Results: Harmonic harvesting significantly reduced harvest time (24.6 ± 6.1 vs. 32.8 ± 7.4 minutes, p < 0.001), clip usage, and improved free-flow volume (78 ± 21 vs. 65 ± 18 mL/min, p < 0.001). Rates of IMA injury, postoperative bleeding, sternal wound infection, and 6-month graft patency were comparable between groups.

Conclusions: Skeletonized IMA harvesting with harmonic ultrasonic shears is a safe, reproducible technique that improves operative efficiency and conduit quality without compromising early clinical or graft outcomes. Broader adoption of this approach may facilitate wider application of arterial revascularization strategies.