Arteriotomy closure by glued patch in the porcine carotid artery.
BACKGROUND
A thoracoscopic approach to coronary bypass grafting warrants renewed search for facilitated vascular anastomosis methods. We reassessed tissue adhesion, sealing properties, and histotoxicity of iso-butyl-cyanoacrylate, in a simplified anastomosis model.


METHODS
In 12 Dutch landrace pigs, five arteriotomies were made in each carotid artery. The arteriotomies were closed by conventional microvascular suturing or by pericardial patch (Peri-Strips) and iso-butyl-cyanoacrylate. The animals were sacrificed at 2 hours (n = 2), 2 days (n = 5), and 4 weeks (n = 5). The arteries were examined by flow measurement, angiography, and histologic analysis.


RESULTS
The time required to close arteriotomies by conventional suturing was 257 +/- 43 seconds (mean +/- SD) and by glued patch 51 +/- 27 seconds (p < 0.001). In all arteriotomies covered by glued patch, complete hemostasis was obtained. At 2 days and 4 weeks, with both methods the same histologic results were observed. At follow-up, all carotid arteries were patent without stenoses.


CONCLUSIONS
Arteriotomy closure by glued patch was simple, fast, reliable, and without signs of histotoxicity. Adhesives deserve to be reconsidered as an alternative to suturing in closed chest beating-heart coronary surgery.
Bastiaanse
J
J
Department of Cardiology, Heart Lung Institute, Utrecht University Medical Center, The Netherlands.
Borst
C
C
van der Helm
Y J
YJ
Loo
K H
KH
Gründeman
P F
PF
D000714:Anastomosis, Surgical; D000818:Animals; D001783:Blood Flow Velocity / Q000502:physiology; D001807:Blood Vessel Prosthesis; D002015:Bucrylate; D002339:Carotid Arteries / Q000473:pathology / Q000601:surgery; D001026:Coronary Artery Bypass; D013552:Swine; D013906:Thoracoscopy; D014014:Tissue Adhesives; D014654:Vascular Patency / Q000502:physiology
D014014:Tissue Adhesives; D002015:Bucrylate