Long-term effects in distal coronary anastomoses using different adhesives in a porcine off-pump model.
OBJECTIVE
Adhesives are useful supplements to seal distal coronary anastomoses, particularly in patients who receive less-invasive coupling techniques. Information regarding long-term structural effects after application, however, is limited. The purpose of this large animal study was to examine the effects of 3 different commercially available surgical adhesives.


METHODS
Twelve end-to-side anastomoses were created between the left internal thoracic artery and the left anterior descending coronary artery in a porcine beating heart model. Three different adhesives were applied externally and circumferentially to the anastomosis site. In group I (n = 4) gelatin-resorcinol-formaldehyde glue (Cardial, Technopole, Sainte-Etienne, France), in group II (n = 4) n-butyl-2-cyanoacrylate glue, and in group III (n = 4) albumin-glutaraldehyde glue were used. All anastomoses were examined intraoperatively by flow measurement. After 3 months the anastomoses were reassessed for patency and the vessels were evaluated histologically.


RESULTS
By means of 4 stay sutures and subsequent glue application, anastomoses could be created successfully on the first attempt in all animals. Perioperative flow through the left internal thoracic artery was similar in all groups. In 4 animals an additional suture was placed to control bleeding. After 3 months, the patency rate was 83.3% (10/12). In group I all anastomoses were patent whereas in both groups II and III one anastomosis was occluded. None of the adhesives caused impaired vessel wall healing but they did demonstrate moderate-to-dense adhesions to the surrounding tissue. On histologic examination, gelantin-resorcinol-formaldehyde glue exhibited minimal tissue reaction (foreign-body granuloma) whereas n-butyl-2-cyanoacrylate glue showed moderate reaction. In contrast, albumin-glutaraldehyde glue caused severe inflammatory reaction with extensive fibroblastic proliferation.


CONCLUSIONS
Construction of an end-to-side internal thoracic artery-coronary artery sleeve anastomosis using adhesives was feasible in the pig. Among the tissue adhesives used in this study, gelantin-resorcinol-formaldehyde glue appeared to be superior to cyanoacrylate and albumin-glutaraldehyde glue. The latter one, however, caused severe adverse histologic effects and thus cannot be recommended for bonding coronary anastomoses.
Wippermann
Jens
J
Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany. jens.wippermann@uk-koeln.de
Konstas
Christo
C
Breuer
Martin
M
Kosmehl
Hartwig
H
Wahlers
Thorsten
T
Albes
Johannes M
JM
D000714:Anastomosis, Surgical; D000818:Animals; D001026:Coronary Artery Bypass; D047549:Coronary Artery Bypass, Off-Pump; D003331:Coronary Vessels / Q000601:surgery; D004338:Drug Combinations; D004659:Enbucrilate / Q000031:analogs & derivatives / Q000627:therapeutic use; D005557:Formaldehyde / Q000627:therapeutic use; D005780:Gelatin / Q000627:therapeutic use; D008323:Mammary Arteries / Q000601:surgery; D023421:Models, Animal; D011506:Proteins / Q000627:therapeutic use; D012118:Resorcinols / Q000627:therapeutic use; D013552:Swine; D013997:Time Factors; D014014:Tissue Adhesives / Q000627:therapeutic use*; D014654:Vascular Patency
C472676:Bio-glue; D004338:Drug Combinations; D011506:Proteins; D012118:Resorcinols; D014014:Tissue Adhesives; C027813:gelatin-resorcinol-formaldehyde tissue adhesive; D005557:Formaldehyde; D005780:Gelatin; D004659:Enbucrilate