title: S2 connector versus suture: distal coronary anastomosis remodeling, patency, and function in the pig.
abstract: BACKGROUND
  Anastomotic connectors could be the key to less invasive bypass surgery, including endoscopic procedures, but equivalence to conventional suturing needs to be established. A novel distal coronary connector was tested pre-clinically for safety and efficacy in comparison to conventional suturing.
  
  
  RESULTS
  Left internal thoracic to left anterior descending coronary artery bypasses were constructed off-pump in 35 pigs (73+/-8 kg). An intraluminal metal connector (S2AS) was used in 21 and conventional suturing in 14 animals. S2AS anastomosis construction was easier achieved in one-fourth of the conventional construction time (3.7+/-0.7 versus 16.5+/-2.6 minutes; P<0.001). Acute patency tended to be better (P=0.15). All anastomoses were evaluated intraoperatively, and subgroups at 90 and at 180 days. Patency was 100%. An effective remodeling response was observed in all groups, resulting in unobstructed anastomoses with excellent hemodynamic performance (fractional flow reserve > or = 0.93 at 180 days). At 6 months, the noncompliant connector was covered with stabilized neointima that was thinner than found on the suture line (0.10+/-0.04 versus 0.31+/-0.13 mm; P=0.01). The connector induced less lumen loss (-0.6+/-6.5 versus 21.6+/-19%; P=0.03). The initial side-to-side configuration had remodeled to an end-to-side shape as intended.
  
  
  CONCLUSIONS
  In the porcine model, the connector rapidly and consistently produced high-quality anastomoses that fully met current standards on patency and function. Unconventional aspects like a noncompliant intraluminal ring and a side-to-side to end-to-side converted configuration did not interfere with favorable anastomosis remodeling. These findings shed a new light on the anatomical prerequisites for anastomosis patency.
authors.affiliation: Cardiothoracic Surgeon, Isala Klinieken (Location: Weezenlanden, Groot Wezenland 20), P.O. Box 10500, 8000 GM Zwolle, Netherlands. w.suyker@isala.nl
authors.forename: Willem J L
authors.initials: WJ
authors.lastname: Suyker
authors.forename: John P
authors.initials: JP
authors.lastname: Matonick
authors.forename: Paul T W
authors.initials: PT
authors.lastname: Suyker
authors.forename: Aart Brutel
authors.initials: AB
authors.lastname: de la Rivière
authors.forename: Marc P
authors.initials: MP
authors.lastname: Buijsrogge
authors.forename: Ricardo P J
authors.initials: RP
authors.lastname: Budde
authors.forename: Cees W J
authors.initials: CW
authors.lastname: Verlaan
authors.forename: Gerard
authors.initials: G
authors.lastname: Pasterkamp
authors.forename: Paul F
authors.initials: PF
authors.lastname: Gründeman
authors.forename: Cornelius
authors.initials: C
authors.lastname: Borst
mesh_terms: D000818:Animals; D017023:Coronary Angiography; D047549:Coronary Artery Bypass, Off-Pump / Q000295:instrumentation / Q000379:methods; D016319:Corrosion Casting; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D005549:Foreign-Body Reaction / Q000209:etiology; D006083:Graft Occlusion, Vascular; D006439:Hemodynamics; D020007:Implants, Experimental; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000295:instrumentation* / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology; D013528:Surgical Staplers; D017792:Surgical Stapling; D034421:Sus scrofa; D013536:Suture Techniques; D014654:Vascular Patency; D014945:Wound Healing