A Retrospective Study of Coronary Artery Bypass Grafting with Low-Thermal Plasma Dissection Device Compared to Conventional Monopolar Electrosurgery

Abstract

Introduction: The objective of this study is to compare the effects of conventional monopolar electrosurgery (CMES) and low-thermal plasma kinetic cautery (PKC) on complications such as bleeding, abnormal wound healing, pain, and drainage in patients who underwent on-pump coronary artery bypass grafting (CABG).

Methods: This retrospective clinical study included 258 patients undergoing CABG; the patients were randomized to PKC (PEAK PlasmaBlade, n=153) and CMES (n=105) groups. The patients' clinical data were examined retrospectively for biochemical variables, postoperative drainage, post-surgery erythrocyte suspension transfusion count, surgical site pain examined with visual analogue scale (VAS), and wound healing. Two-sided P-value > 0.05 was considered as statistically significant.

Results: The median post-surgery erythrocyte suspension transfusion number was significantly lower with PKC compared to CMES (0 [0-1] vs. 1 [1-4], respectively, P<0.001). Mean postoperative drain output and time until removal of drain tubes were significantly lower with PKC compared to CMES (300±113 vs. 547±192 and 1.95±1.5 vs. 2.44±1.8; P<0.001 and P=0.025, respectively). Mean VAS score for spontaneous and cough-induced pain were significantly lower with PKC compared to CMES (1.98±1.51 vs. 3.94± 2.09 and 3.76±1.46 vs. 5.6±1.92; P<0.001 for both comparisons). Reoperation due to bleeding was significantly higher with CMES compared to PKC (0 vs. 11 [7.2%], P=0.001).

Conclusion: Use of PKC during CABG considerably reduces postoperative drainage, need for blood transfusion, reoperation due to bleeding, and postoperative pain. PCK appears to be a good alternative to CMES for CABG.

Keywords: Coronary Artery Bypass; Electrosurgery; Pain, Postoperative; Visual Analog Scale.

Fig. 1

Comparison of the preoperative and postoperative hematologic and biochemical parameters between the low-thermal plasma dissection device (or plasma kinetic cautery [PKC]) group and the conventional monopolar electrosurgery (CMES) group. Statistical analysis of the differences between the groups was carried out with Mann-Whitney U test. The analyses of the preoperative and postoperative values of both groups were carried out with related-samples Wilcoxon signed-rank test. Two-sided P-value > 0.05 was considered statistically significant. A to D) Mean blood urea nitrogen (BUN) and creatinine value, and mean platelet and white blood cell (WBC) count were not found to be statistically significant in between-group analyses. Within-group analyses results are shown as related-samples Wilcoxon signed-rank test; 95% confidence interval (CI); lower, upper, P: CMES group BUN (-2, 3.5, P=0.645) and PKC group BUN (-4.5, 3, P=0.678), CMES group creatinine (0.08, 0.175, P<0.001) and PKC group creatinine (0.1, 0.17, P<0.001), CMES group platelet count (-18.5,19, P=0.98) and PKC group platelet count (-66,-26, P<0.001), and CMES group WBC (0.1, 1.15, P=0.02) and PKC group WBC (0.75, 2, P<0.001). E to F) The mean preoperative and postoperative C-reactive protein (CRP) (P=0.081 and P=0.539, respectively) and aspartate aminotransferase (AST) (P=0.960 and P=0165, respectively) values were not statistically significantly different in the between-group analyses. In within-group analyses, the postoperative values of both groups were significantly increased compared to preoperative values (CMES group CRP [26.45, 35.59, P<0.001] and PKC group CRP [13.98, 30.97, P<0.001], CMES group AST [15.28, 23.97, P<0.001] and PKC group AST [16.83, 29.51, P<0.001]).

Fig. 2

Intraoperative images. A) Image of the subcostal tissue after harvesting left internal mammary artery (LIMA) using the low-thermal plasma dissection device (or plasma kinetic cautery [PKC]) shows the presence of minimal thermal damage to the surrounding tissue (white asterisk). B) Image of the subcostal tissue after harvesting LIMA by the conventional monopolar electrosurgery (CMES) showing the presence of serious thermal damage to the surrounding tissue; burnt tissue can be clearly observed (white asterisk). C) Intraoperative image of excised thymus tissue by PKC incision shows a sharp cutting edge without any burning. D) Intraoperative image of excised thymus tissue by CMES incision shows an irregular cutting edge with significant burnt tissue. E to F) Histological features of LIMA graft after preparation with PKC (E) and CMES (F) at 500 µm (E) and 100 µm (F) represent similar findings with minimal effect.