Briefly occlusive coronary anastomosis with tissue adhesive.
OBJECTIVE
We assessed the feasibility of a facilitated, briefly occlusive, sutureless coronary anastomosis technique in which side-to-side preglued (octylcyanoacrylate adhesive) bounded walls were opened by a conventional arteriotomy.


METHODS
In low-flow (prothrombotic milieu, <or=15 mL/min, n = 8) and high-flow (approximately 50 mL/min, n = 8) porcine model of off-pump internal thoracic artery-left anterior descending coronary artery bypass, the anastomoses were evaluated intraoperatively (n = 16) and at 5 weeks (n = 14, with 2 evaluated at 2.5 weeks). The anastomoses were examined by flow measurement, angiography, and histologic studies.


RESULTS
Coronary occlusion lasted a median of 1.6 minutes (15th-85th percentile 1.4-1.8 minutes), and anastomosis construction required a median of 5.5 minutes (15th-85th percentile 4.2-6.5 minutes). At 5 weeks all anastomoses were fully patent (FitzGibbon grade A), with an angiographic appearance similar to an end-to-side anastomotic configuration.


CONCLUSIONS
The briefly occlusive adhesive anastomosis technique proved to be feasible in off-pump bypass surgery in the pig even under prothrombotic low bypass graft flow conditions (<or=15 mL/min). Further studies are warranted to investigate the applicability of this technique to endoscopic bypass surgery on the beating heart.
Buijsrogge
Marc P
MP
Heart Lung Center Utrecht, University Medical Center Utrecht, The Netherlands.
Verlaan
Cees W J
CW
Gründeman
Paul F
PF
Borst
Cornelius
C
D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods*; D000818:Animals; D001783:Blood Flow Velocity; D002315:Cardiopulmonary Bypass / Q000379:methods; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods*; D003331:Coronary Vessels / Q000473:pathology / Q000601:surgery*; D003487:Cyanoacrylates / Q000009:adverse effects / Q000627:therapeutic use*; D004195:Disease Models, Animal; D004353:Drug Evaluation, Preclinical; D005240:Feasibility Studies; D005260:Female; D007249:Inflammation; D008323:Mammary Arteries / Q000000981:diagnostic imaging / Q000473:pathology / Q000637:transplantation*; D008866:Microsurgery / Q000295:instrumentation / Q000379:methods; D009336:Necrosis; D011673:Pulsatile Flow; D013552:Swine; D013997:Time Factors; D014014:Tissue Adhesives / Q000009:adverse effects / Q000627:therapeutic use*; D014654:Vascular Patency
D003487:Cyanoacrylates; D014014:Tissue Adhesives; C119247:octylcyanoacrylate