Sutureless coronary anastomosis with an anastomotic device and tissue adhesive in off-pump porcine coronary bypass grafting.
OBJECTIVE
In the search for a facilitated coronary artery anastomosis, we assessed the feasibility of a hybrid anastomosis technique that used a prototype anastomotic device with an extraluminal frame (crinoline-like) and octyl-cyanoacrylate adhesive.


METHODS
During off-pump coronary artery bypass grafting in pigs (n = 8), a left internal thoracic artery-right coronary artery anastomosis was constructed and evaluated during the operation and at 5 postoperative weeks. The anastomosis was examined by flow measurement, angiography, intraluminal cast geometric analysis, and histologic analysis.


RESULTS
Anastomosis construction required 6.2 +/- 1.3 minutes (mean +/- SD). At 5 weeks all anastomoses were fully patent, with minor anastomotic diameter narrowing (median 16%, 15th-85th percentile 16%-26%). After 30-second graft occlusion, median peak hyperemic flow response was 5.0 (15th-85th percentile 4.4-6.5). As a result of complete, streamlining filling of anastomotic wall recesses by neointima formation, more intimal hyperplasia was found in the crinoline-adhesive anastomoses than in sutured control anastomoses. No excessive, lumen-narrowing neointima formation was observed, however.


CONCLUSIONS
The hybrid coronary anastomosis technique was feasible without any need for dedicated application tools. If technical improvements can be realized, the hybrid technique may provide an alternative to manual suturing.
Buijsrogge
Marc P
MP
Heart Lung Center Utrecht, University Medical Center Utrecht, The Netherlands.
Scheltes
Jules S
JS
Heikens
Martijn
M
Gründeman
Paul F
PF
Pistecky
Peter V
PV
Borst
Cornelius
C
D000714:Anastomosis, Surgical / Q000295:instrumentation; D000818:Animals; D020099:Coated Materials, Biocompatible / Q000627:therapeutic use; D003131:Combined Modality Therapy; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000295:instrumentation*; D003331:Coronary Vessels / Q000473:pathology / Q000601:surgery*; D003487:Cyanoacrylates / Q000627:therapeutic use*; D004867:Equipment Design; D004869:Equipment Safety; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006488:Hemostasis, Surgical / Q000295:instrumentation; D006965:Hyperplasia / Q000209:etiology; D023421:Models, Animal; D009336:Necrosis; D013536:Suture Techniques / Q000295:instrumentation*; D013552:Swine; D013997:Time Factors; D014014:Tissue Adhesives; D016896:Treatment Outcome
D020099:Coated Materials, Biocompatible; D003487:Cyanoacrylates; D014014:Tissue Adhesives; C119247:octylcyanoacrylate