title: Harmonic scalpel reduces bleeding and postoperative complications in redo cardiac surgery.
abstract: BACKGROUND
  Intraoperative and postoperative bleeding and injuries to cardiac structures are among the main determinants of complications and hospital and intensive care unit stay after cardiac reinterventions. The harmonic scalpel has been reported to achieve optimal tissue dissection with little blood loss. The present retrospective work was performed to evaluate the safety and usefulness of this device in redo cardiac surgery.
  
  
  METHODS
  Ninety-six redo cardiac surgery patients were operated on with the use of harmonic scalpel, and 105 redo patients operated on by traditional electrocautery and scissors were selected from our database and served as controls. Intraoperative and postoperative data of the two groups were collected and compared. Univariate and multiple logistic regression analyses were performed for identification of factors associated with death and with major and minor complications in the overall study population and in both groups, separately.
  
  
  RESULTS
  Although mortality and major postoperative morbidity were comparable in the two groups, harmonic scalpel patients presented markedly reduced postoperative bleeding, lower incidence of minor complications, cardiac injuries, major arrhythmias, and need for transfusions. Operative time and mean intensive care unit stay were shorter. Use of ultrascissor was found to be a protective factor against minor morbidity at multivariate analysis.
  
  
  CONCLUSIONS
  Our data suggest that harmonic scalpel is safe and is associated with better in-hospital outcome and lower postoperative blood loss in redo cardiac surgery.
authors.affiliation: Division of Cardiac Surgery, Department of Cardiovascular Medicine, Catholic University, Rome, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Luciani
authors.forename: Amedeo
authors.initials: A
authors.lastname: Anselmi
authors.forename: Mario
authors.initials: M
authors.lastname: Gaudino
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Nasso
authors.forename: Franco
authors.initials: F
authors.lastname: Glieca
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Martinelli
authors.forename: Filippo
authors.initials: F
authors.lastname: Santarelli
authors.forename: Mario
authors.initials: M
authors.lastname: Perisano
authors.forename: Gianfederico
authors.initials: G
authors.lastname: Possati
mesh_terms: D000368:Aged; D001803:Blood Transfusion; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D005260:Female; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D019106:Postoperative Hemorrhage / Q000517:prevention & control; D012086:Reoperation; D012307:Risk Factors; D013525:Surgical Instruments; D016019:Survival Analysis; D016896:Treatment Outcome; D014464:Ultrasonic Therapy / Q000295:instrumentation*