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J Thorac Cardiovasc Surg 2002;124:1256-1258
© 2002 The American Association for Thoracic Surgery
Brief Communications |
From the Department of Cardiovascular Surgerya and Division of Pediatric Cardiology,b University Hospital, Bern, Switzerland.
Received for publication Nov 21, 2001. Accepted for publication April 23, 2002. Address for reprints: P. A. Berdat, MD, Clinic for Cardiovascular Surgery, Swiss Cardiovascular Center Bern, Inselspital, CH-3010 Bern, Switzerland (E-mail: pascal.berdat{at}insel.ch).
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1-3 Consequently, short- and long-term patency and clinical outcome might be improved by reducing anastomotic stricture, thrombosis, and occlusion. Interrupted sutures might therefore be preferable in children because of the growth of vascular structures and in cases in which low-pressure vessels are involved. 4 However, because of the time-consuming process, which might affect immediate outcome by prolonging cardiopulmonary bypass and myocardial ischemia, requiring considerable manipulation of the vessels, and requiring extensive knot tying for confection of such anastomoses, many surgeons prefer to use running sutures. Coalescent Surgical, Inc (Sunnyvale, Calif) has developed a nitinol self-coiling penetrating clip, the U-clip, to facilitate confection of vascular anastomoses in an interrupted fashion. The device consists of a vascular needle on a nitinol filament of 3 or 6 cm with a nitinol clip mounted on a release mechanism at the end (Figure 1). When the release mechanism is squeezed, the clip is deployed, self-recoiling, closing, and eliminating knot tying and assisted suture management (Figure 2). Five different sizes of U-clips exist to fit a broad spectrum of vessels.
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5 and compared with polypropylene sutures in a carotid arteriotomy closure model. Intraoperative, 1-week, 8-week, and 26-week angiograms and histopathologic examinations showed excellent graft patency and healing characteristics. By October 2000, CE marking was obtained, and the device was introduced to the European market. We report the first successful clinical use of the U-clip in congenital cardiac surgery and our initial clinical experience with this device in cardiac and peripheral vascular procedures. Patients and methods
U-clips of different sizes were used for confection of various vascular anastomoses in 11 patients with a mean age of 46.2 ± 31.8 years (range, 4 days to 76.2 years).
The U-clips were applied as described earlier (Figure 2
). Care was taken to evenly distribute the U-clips around the anastomotic edges to create an optimal anastomotic geometry and local hemostasis.
Results
U-clips were used in 82% of all vascular anastomoses made (Figure 3). In 5 patients the U-clips were used for confection of 12 coronary bypass graft anastomoses with saphenous vein grafts, radial arteries, and internal thoracic arteries. U-clips of size 50 were used proximally, and U-clips of sizes 18 and 20 were used distally.
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In 3 adults reconstruction of peripheral vessels was performed with U-clips. In one patient reconstruction of the popliteal artery was performed with end-to-end anastomosis (size 50). In the second patient reconstruction of the external iliac artery after cannulation for cardiopulmonary bypass was performed (size 50). In another patient with chronic renal failure, confection of a Cimino-Breshia arteriovenous fistula on the forearm was performed (size 18).
In all cases the use of the U-clips was easy, and no technical difficulties were encountered. Immediate anastomotic hemostasis was excellent, even with the use of foreign material. No special surgical instrument was needed for confection of anastomoses with the U-clip. Although we did not measure the precise time for construction of such anastomoses, this technique seemed much faster than conventional interrupted sutures and as fast as continuous sutures. Excellent flow was demonstrated in all cases by means of transit-time Doppler scanning or invasive pressure gradient measurements and confirmed by means of postoperative echocardiography when appropriate. Short-term outcome with a mean follow-up of 6 ± 3.8 months was uneventful in all but the newborn with pulmonary atresia with intact ventricular septum, who died suddenly after 62 days.
Comment
The new U-clips allow easy, precise, and time-sparing confection of vascular anastomoses in an interrupted fashion in the whole field of cardiovascular surgery. Its application might prevent anastomotic stricture, thrombosis, and occlusion caused by purse-string effects or growth restriction in the pediatric cardiac group by allowing for greater anastomotic diameter, pulsatility of the anastomosis, and unrestricted growth potential in comparison with running sutures. Consequently, long-term patency of bypass grafts and vascular anastomoses, as well as clinical outcome after cardiovascular surgical procedures, will be improved.
References
This article has been cited by other articles:
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  P. A. Berdat, J. L. Lavanchy, F. Schonhoff, M. Pavlovic, J.-P. Pfammatter, and T. P. Carrel Growth potential of U-clipTM interrupted versus polypropylene running suture anastomosis in congenital cardiac surgery: intermediate term results Interactive CardioVascular and Thoracic Surgery, October 1, 2009; 9(4): 565 - 570. [Abstract] [Full Text] [PDF]
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 V. Gober, P. Berdat, M. Pavlovic, J.-P. Pfammatter, and T. P. Carrel Adverse Mid-Term Outcome Following RVOT Reconstruction Using the Contegra Valved Bovine Jugular Vein Ann. Thorac. Surg., February 1, 2005; 79(2): 625 - 631. [Abstract] [Full Text] [PDF]
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 T. Carrel, L. Englberger, D. Keller, S. Windecker, B. Meier, and F. Eckstein Clinical and angiographic results after mechanical connection for distal anastomosis in coronary surgery J. Thorac. Cardiovasc. Surg., June 1, 2004; 127(6): 1632 - 1640. [Abstract] [Full Text] [PDF]
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T. P. Carrel, F. S. Eckstein, L. Englberger, P. A. Berdat, and J. Schmidli Clinical experience with devices for facilitated anastomoses in coronary artery bypass surgery Ann. Thorac. Surg., March 1, 2004; 77(3): 1110 - 1120. [Abstract] [Full Text] [PDF]
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