Comparison of conventional electrocautery vs Plasmablade™ for internal thoracic artery harvesting

Background: Use of at least one internal thoracic artery (ITA) graft with preserved endothelial function improves survival, cardiac event free survival and quality of life in coronary artery bypass grafting (CABG) patients. PlasmaBlade™ uses pulsed radiofrequency energy to enable precision cutting and coagulating at the point of application, without the thermal damage to surrounding tissues that is normally seen with conventional electrocautery. In this study, we aim to demonstrate that, harvesting ITA with a PlasmaBlade™ is more effective and safer in preserving integrity of intima and pedicle of ITA than electrocautery. Methods: A total of forty patients were recruited and then randomized to undergo ITA harvesting with PlasmaBlade™ (Group I) (n=20) or electrocautery (Group II) (n=20) for this study. ITA sections (intima and pedicle) were stained with Hematoxylin and Eosin, van Gieson's and Masson's trichrome stains and their integrity were morphologically assessed using light microscopy. Results: Histological examination revealed that, endothelium was well preserved and endothelial injury scores were significantly lower in Group I compared to Group II (p=0.020). Bleeding scores for the vessel wall and the pedicle were also significantly lower in Group I compared to Group II (p=0.020). Mean injury zone width was significantly shorter in Group I (0.335 mm and 0.730 mm in Group I and II respectively) (p=0.000). Conclusion: As a result, PlasmaBlade™ is safer and more effective in preserving integrity of intima and pedicle of ITA than electrocautery for ITA harvesting in CABG. A well preserved endothelial function might provide higher graft patency, survival and event free survival rates.