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J Thorac Cardiovasc Surg 1996;111:1063-1072
© 1996 Mosby, Inc.

SURGERY FOR ACQUIRED HEART DISEASE

INFLUENCE OF SUTURE TECHNIQUE AND SUTURE MATERIAL SELECTION ON THE MECHANICS OF END-TO-END AND END-TO-SIDE ANASTOMOSES

From Loyola University Medical Center, Department of Surgery, Maywood, Ill., and Hines Veterans Administration Hospital, Hines, Ill.

Received for publication Jan. 4, 1995. Accepted for publication June 12, 1995. Address for reprints: Philip B. Dobrin, MD, PhD, Loyola University Medical Center, Department of Surgery, 2160 S. First Ave., Maywood, IL 60153.

Abstract

Experiments were performed in dogs to evaluate the mechanics of 26 end-to-end and 42 end-to-side artery-vein graft anastomoses constructed with continuous polypropylene sutures (Surgilene; Davis & Geck, Division of American Cyanamid Co., Danbury, Conn.), continuous polybutester sutures (Novafil; Davis & Geck), and interrupted stitches with either suture material. After construction, the grafts and adjoining arteries were excised, mounted in vitro at in situ length, filled with a dilute barium sulfate suspension, and pressurized in 25 mm Hg steps up to 200 mm Hg. Radiographs were obtained at each pressure. The computed cross-sectional areas of the anastomoses were compared with those of the native arteries at corresponding pressures. Results showed that for the end-to-end anastomoses at 100 mm Hg the cross-sectional areas of the continuous Surgilene anastomoses were 70% of the native artery cross-sectional areas, the cross-sectional areas of the continuous Novafil anastomoses were 90% of the native artery cross-sectional areas, and the cross-sectional areas of the interrupted anastomoses were 107% of the native artery cross-sectional areas (p < 0.05). At physiologic pressures, there were no differences in compliance among the three types of anastomosis. These data suggest that when constructing an end-to-end anastomosis in a small vessel, one should use an interrupted suture line or possibly continuous polybutester suture. Forty-two end-to-side anastomoses demonstrated no differences in cross-sectional areas or compliance for the three suture techniques. This suggests that, unlike with end-to-end anastomoses, when constructing an end-to-side anastomosis in patients any of the three suture techniques may be acceptable. (J THORACCARDIOVASCSURG1996;111:1063-72)

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