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J Thorac Cardiovasc Surg 2002;123:788-794
© 2002 The American Association for Thoracic Surgery

Evolving Technology (ET)

Sutureless coronary anastomosis with an anastomotic device and tissue adhesive in off-pump porcine coronary bypass grafting

From the Heart Lung Center Utrecht, University Medical Center Utrecht, Utrecht,^a and Department of Design, Engineering and Production, Delft University of Technology, Delft,^b The Netherlands.

Received for publication June 7, 2001. Revisions requested Aug 1, 2001; revisions received Aug 29, 2001. Accepted for publication Sept 10, 2001. Address for reprints: Cornelius Borst, MD, PhD, Professor of Experimental Cardiology, University Medical Center Utrecht (Room G02.523), Heart Lung Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands (E-mail: c.borst{at}hli.azu.nl).

Objective: In the search for a facilitated coronary artery anastomosis, we assessed the feasibility of a hybrid anastomosis technique that used a prototype anastomotic device with an extraluminal frame (crinoline-like) and octyl-cyanoacrylate adhesive.
Methods: During off-pump coronary artery bypass grafting in pigs (n = 8), a left internal thoracic artery-right coronary artery anastomosis was constructed and evaluated during the operation and at 5 postoperative weeks. The anastomosis was examined by flow measurement, angiography, intraluminal cast geometric analysis, and histologic analysis.
Results: Anastomosis construction required 6.2 ± 1.3 minutes (mean ± SD). At 5 weeks all anastomoses were fully patent, with minor anastomotic diameter narrowing (median 16%, 15th-85th percentile 16%-26%). After 30-second graft occlusion, median peak hyperemic flow response was 5.0 (15th-85th percentile 4.4-6.5). As a result of complete, streamlining filling of anastomotic wall recesses by neointima formation, more intimal hyperplasia was found in the crinoline-adhesive anastomoses than in sutured control anastomoses. No excessive, lumen-narrowing neointima formation was observed, however.
Conclusions: The hybrid coronary anastomosis technique was feasible without any need for dedicated application tools. If technical improvements can be realized, the hybrid technique may provide an alternative to manual suturing.

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