title: Internal thoracic artery to left anterior descending anastomosis performed on the beating heart by endoscopic robot assistance using a new distal connector.
abstract: BACKGROUND
  Automated distal connecting devices have been recently introduced to facilitate coronary anastomosis. This could have a large impact on the capacity of robotic systems to perform completely endoscopic off-pump bypass, where the quality of anastomosis and the prolonged operative time for the performance of the anastomosis have until now been cause for concern. Our group tried to determine the feasibility and efficacy of the JoMed distal graft connector using the ZEUS robotic system.
  
  
  METHODS
  Six swine, with a mean weight of 25.8 (standard deviation [SD] 2.2) kg, underwent endoscopic off-pump internal thoracic artery-left anterior descending (ITA-LAD) anastomosis with a special stabilizing system using ZEUS robotic assistance. The anastomosis was performed with the JoMed distal connector.
  
  
  RESULTS
  The connector was employed successfully in 4 of 6 cases using a special delivery instrument. Two animals fibrillated within 2 minutes after the application of proximal occluding snares and were excluded from the analysis. The total device deployment time was 2 minutes 4 seconds (SD 50 s) in 4 of 6 survivors, which remained hemodynamically stable and in sinus rhythm until euthanasia. Coronary angiography and transonic flow measurements were used to verify patency.
  
  
  CONCLUSIONS
  The JoMed distal graft connector may facilitate the use of robot-assisted endoscopic bypass on a beating heart. Long-term patency issues will need to be assessed.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, 2500 MetroHealth Dr., 3rd Fl. Hamann Bldg., Cleveland, OH 44109-1998, USA. gillis@ccf.org
authors.forename: Inderjit S
authors.initials: IS
authors.lastname: Gill
authors.forename: Hironori
authors.initials: H
authors.lastname: Izutani
mesh_terms: D000818:Animals; D017023:Coronary Angiography; D047549:Coronary Artery Bypass, Off-Pump / Q000295:instrumentation*; D019723:Endoscopes; D004867:Equipment Design; D005240:Feasibility Studies; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000295:instrumentation*; D015203:Reproducibility of Results; D012371:Robotics / Q000295:instrumentation*; D013552:Swine