A new nonocclusive laser-assisted coronary anastomotic connector in a rabbit model.
OBJECTIVE
The Excimer laser-assisted nonocclusive anastomotic technique is a nonocclusive, facilitated bypass technique that is currently Conformité Européenne and Food and Drug Administration approved for clinical application in neurosurgery. In the present study, we assessed the safety and feasibility of a newly developed Excimer laser-assisted nonocclusive anastomosis-based prototype coronary anastomotic connector in an acute rabbit abdominal aortic bypass model before application in experimental coronary bypass surgery. In addition, 2 sealants were tested to facilitate anastomotic hemostasis in the current device prototype.


METHODS
A total of 40 anastomoses were constructed on the abdominal aorta (3.5 mm outer diameter) of 10 rabbits. The anastomotic circumference was sealed by a surgical sealant to obtain complete hemostasis (BioGlue vs TachoSil). The anastomoses were evaluated by flow measurements construction time, hemostasis, histologic analysis, and burst pressure testing.


RESULTS
The connector enabled a nonocclusive and fast (6.0 ± 1.7 minutes, mean ± SD [including sealing]) anastomosis construction and complete hemostasis in 95% (35/37). Sealing with BioGlue was faster than with TachoSil (19% vs 53% of construction time). Despite technical imperfections (7/40 failures to completely retrieve the flap by the laser), all 40 anastomoses were patent, showed reproducible construction with intima-adventitia apposition, streamlining thrombus coverage of the intraluminal laser rim, and no vessel wall damage. All anastomoses resisted ex vivo supraphysiologic pressures (> 300 mm Hg).


CONCLUSIONS
The results of the present study have demonstrated that the Excimer laser-assisted nonocclusive anastomotic connector is safe and reliable and can be efficiently applied in an acute rabbit abdominal aortic bypass model. Provided the limitations can be addressed, this easy-to-use and nonocclusive technique has the potential to facilitate minimally invasive coronary bypass surgery.
Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: dsteche2@umcutrecht.nl.
David
D
Stecher
Department of Neurosurgery of the Brain Division, University Medical Center Utrecht, Utrecht, The Netherlands.
Bart
B
de Boer
Department of Neurosurgery of the Brain Division, University Medical Center Utrecht, Utrecht, The Netherlands.
Cornelis A F
CAF
Tulleken
Experimental Cardiology of the Heart and Lungs Division, University Medical Center Utrecht, Utrecht, The Netherlands.
Gerard
G
Pasterkamp
Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
Lex A
LA
van Herwerden
Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
Marc P
MP
Buijsrogge
D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000295:instrumentation; D000818:Animals; D001012:Aorta, Abdominal / Q000601:surgery*; D004867:Equipment Design; D005240:Feasibility Studies; D053685:Laser Therapy / Q000009:adverse effects / Q000295:instrumentation*; D054018:Lasers, Excimer / Q000627:therapeutic use*; D023421:Models, Animal; D011817:Rabbits; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation