JTCS KCI
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Suyker, W. J. L.
Right arrow Articles by Gründeman, P. F.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Suyker, W. J. L.
Right arrow Articles by Gründeman, P. F.
Related Collections
Right arrow Minimally invasive surgery

J Thorac Cardiovasc Surg 2004;128:331
© 2004 The American Association for Thoracic Surgery

Letter to the editor

Reply to the Editor

Willem J. L. Suyker, MDa,c, Marc P. Buijsrogge, MD, PhDa, Paul T. W. Suyker, MSc, MBAc, Cees W. J. Verlaanb, Cornelius Borst, MD, PhDb, Paul F. Gründeman, MD, PhDb

a Isala Clinics, Zwolle, The Netherlands
b Heart Lung Center Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands
c iiTech BV, Amsterdam, The Netherlands

We appreciate Dr Konstantinov's encouraging words and fascinating account of the early pioneering work on coronary staplers by Drs Demikhov and Kolesov. We believe that the S2 connector design is about to overcome the 3 main obstacles that, according to Dr Konstantinov, to date have precluded the use of coronary staplers as invented in the 1950s and 1960s.

First, S2 coronary stapling is an easier and faster bypass grafting method than suturing manually. In subsequent open-chest, beating-heart porcine studies the stapled anastomosis was constructed in 1.8 ± 0.6 (SD) minutes of coronary ischemia time after preloading the graft (1.9 ± 0.5 minutes) versus 11.8 ± 2.7 minutes of ischemia time for the sutured anastomosis (P < .001, unpublished observation). Experiments with the device endoscopically on the beating heart look promising for both anterior and posterior coronary arteries (unpublished observation, Paul Gründeman, MD).

Second, the S2 stapler can deal with both side-to-side and end-to-side anastomoses because the latter is converted from an initially side-to-side configuration by clipping the very end of the graft. The device uses the latest micromanufacturing technology. As a result, it combines effective stapling and ease of use with minimal connector mass and minimal exposure of foreign body material to blood.

Third, the S2 device is designed to stay close to basic surgical principles, which is especially important when handling atherosclerotic vessels. The staples meet the vessel walls in a standardized way, similar to how a surgeon would position his needle, and the applicator allows exerting a precise and direct force on the staples to effect penetration. Transmitting any undue forces to the tissue is minimized to avoid trauma. Tests with human explanted hearts have shown that the system is capable of effectively dealing with severely atherosclerotic coronary arteries (unpublished observation). Clinical evaluation, however, is needed to substantiate these results and determine patency rates in human subjects.

The coronary stapler is indeed a concept that has remained dormant for almost half a century, waiting for both the proper technology and design to enable its effective implementation. Without modern manufacturing technology, the present development would have been prohibitively difficult. Whether this time coronary stapling devices are here to stay remains to be determined. Our current additional porcine data at 3 months in 20 animals (unpublished) warrant initiation of clinical evaluation.





This Article
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Suyker, W. J. L.
Right arrow Articles by Gründeman, P. F.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Suyker, W. J. L.
Right arrow Articles by Gründeman, P. F.
Related Collections
Right arrow Minimally invasive surgery

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS