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J Thorac Cardiovasc Surg 1997;113:621-622
© 1997 Mosby, Inc.

LETTERS TO THE EDITOR

Carbodissection of the internal thoracic artery pedicle

Centinela Hospital Medical Center
Department of Cardiothoracic Surgery
555 East Hardy St., 4th Floor East
Inglewood, CA 90301

To the Editor:

Blake and associates ¹ demonstrated that 40% of internal thoracic arteries (ITAs) harvested by electrocautery were damaged or failed to respond to contractile stimuli. Lesser degrees of damage were documented with the use of an ultrasonic aspirator.

In 1988, I ² described carbodissection of the ITA pedicle to separate the pedicle from the chest wall and facilitate exposure of its branches in an atraumatic manner. A 5 L flow of carbon dioxide is introduced anterior to the ITA pedicle through an 8F pacemaker lead introducer. This rapidly dissects the pedicle from its fascial investments. Gentle downward pressure with the electrocautery spatula exposes the branches, which are then clipped.

My colleagues and I have now used this technique to harvest more than 350 ITAs. The method is simple, inexpensive, requires no special equipment, and eliminates the risk of thermal or sonic injury to the pedicle. In no case to date has an ITA not been used as planned because of carbodissection. The technique allows gentle handling of the pedicle, which almost always has a brisk pulse at the completion of its separation from the chest wall.

12/8/78925

References

1. Blake KL, Watt PAC, Smith JMT, De Souza AC, Spyt TJ, Thurston H. Randomized comparison of ultrasonic aspiration versus conventional electrocautery for dissection of the human internal thoracic artery. J Thorac Cardiovasc Surg 1996;111:1194-9[Abstract/Free Full Text]
   
2. Lee ME. Carbodissection of the internal thoracic artery pedicle. Ann Thorac Surg 1988;46:470-1.[Abstract]
   

This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Myles Edwin Lee Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Lee, M. E. Search for Related Content PubMed PubMed Citation Articles by Lee, M. E.