Internal mammary coronary artery anastomosis by CO2 laser: an acute experimental study.
This study was designed to determine the feasibility of anastomosing the internal mammary artery (IMA) and coronary artery with a carbon dioxide laser in a canine model. Twenty-two mongrel dogs were randomly assigned to two groups: group I (n = 11) underwent laser-assisted vascular anastomosis (LAVA) of the left IMA to the left anterior descending (LAD) coronary artery, whereas in group II (n = 11) the anastomosis was done with the conventional technique (handsewn). Laser methodology was used to micro-weld vessels utilizing a power of 200 mW with a spot size of 500 mu, producing an effective power density of 102 W/cm2 and energy fluence of 9,172 joules/cm2 in a continuous mode at a distance of 2 cm. The short-term patency rate, measured at 2 hours after completion of the anastomosis, was 100% in both groups. The time required to perform the LAVA in group I was significantly shorter than group II (6.27 +/- 0.47 vs 11.6 +/- 0.67 min, p less than 0.05). The mean anastomotic bursting pressure in group I was significantly lower compared to group II (348 +/- 8 vs 402 +/- 9 mmHg, p less than 0.05). Histologic evaluation of all vessels showed moderate thermal injury of the adventitia and media in the laser group. Scanning electron microscopy exhibited a smooth anastomotic area in group I, whereas endothelial and perianastomotic changes with multiple needle craters occurred in group II (conventional anastomosis).(ABSTRACT TRUNCATED AT 250 WORDS)
Basu
S
S
Department of Surgery, Maimonides Medical Center, State University of New York Health Science Center, Brooklyn.
Marini
C P
CP
Coons
M S
MS
Woloszyn
T T
TT
Folliguet
T A
TA
Baumann
F G
FG
Jacobowitz
I J
IJ
D000818:Animals; D003327:Coronary Disease / Q000473:pathology / Q000601:surgery; D004285:Dogs; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000379:methods*; D053685:Laser Therapy / Q000379:methods*; D008297:Male; D008323:Mammary Arteries / Q000648:ultrastructure; D011897:Random Allocation; D013536:Suture Techniques; D014654:Vascular Patency