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J Thorac Cardiovasc Surg 2003;125:385-390
© 2003 The American Association for Thoracic Surgery
Evolving Technology (ET) |
From the Heart Lung Center Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands.
Received for publication Jan 29, 2002. Revisions requested April 24, 2002; revisions received May 21, 2002. Accepted for publication July 30, 2002. Address for reprints: Paul F. Gründeman, MD, PhD, Associate Professor of Experimental Cardiothoracic Surgery, University Medical Center Utrecht (Room G02.523), Heart Lung Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands (E-mail: exp.cardio{at}hli.azu.nl).
Objective: We assessed the feasibility of a facilitated, briefly occlusive, sutureless coronary anastomosis technique in which side-to-side preglued (octylcyanoacrylate adhesive) bounded walls were opened by a conventional arteriotomy.
Methods: In low-flow (prothrombotic milieu,
15 mL/min, n = 8) and high-flow (approximately 50 mL/min, n = 8) porcine model of off-pump internal thoracic artery-left anterior descending coronary artery bypass, the anastomoses were evaluated intraoperatively (n = 16) and at 5 weeks (n = 14, with 2 evaluated at 2.5 weeks). The anastomoses were examined by flow measurement, angiography, and histologic studies.
Results: Coronary occlusion lasted a median of 1.6 minutes (15th-85th percentile 1.4-1.8 minutes), and anastomosis construction required a median of 5.5 minutes (15th-85th percentile 4.2-6.5 minutes). At 5 weeks all anastomoses were fully patent (FitzGibbon grade A), with an angiographic appearance similar to an end-to-side anastomotic configuration.
Conclusions: The briefly occlusive adhesive anastomosis technique proved to be feasible in off-pump bypass surgery in the pig even under prothrombotic low bypass graft flow conditions (
15 mL/min). Further studies are warranted to investigate the applicability of this technique to endoscopic bypass surgery on the beating heart.
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