title: The nonocclusive laser-assisted coronary anastomotic connector in an off-pump porcine bypass model.
abstract: OBJECTIVE
  To facilitate minimally invasive coronary artery bypass grafting, a simplified alternative for hand-sutured anastomoses must be developed. We assessed the feasibility and anastomotic healing of the ameliorated Excimer laser-assisted nonocclusive anastomosis coronary prototype connector in an acute rabbit study (study 1) and in a long-term porcine off-pump coronary bypass study (study 2).
  
  
  METHODS
  Eighteen anastomoses were constructed on the abdominal aorta of the rabbit. In the porcine model, 15 left internal thoracic artery to left anterior descending coronary artery bypasses were evaluated intraoperatively and at 4 hours, 4 and 10 days, 2, 3, and 5 weeks, and 6 months (each n = 2 anastomoses). The anastomoses were examined by angiography, flow measurements, fractional flow reserve, coronary flow reserve, histologic features, and scanning electron microscopy.
  
  
  RESULTS
  In study 1, all 18 anastomoses were patent and resisted supraphysiologic pressures (n = 12, 300 mm Hg). In study 2, the connector enabled nonocclusive and fast (7.7 ± 2.2 minutes, mean ± standard deviation) anastomosis construction. All but 1 of 15 anastomoses (owing to a technical error) were fully patent (FitzGibbon grade A) at follow-up. Histologic examination and scanning electron microscopy demonstrated complete endothelialization of the anastomoses at 10 days. At 6 months, no flow-limiting but streamline-covering intimal hyperplasia was shown (fractional flow reserve, 0.93 ± 0.07 mean ± standard deviation).
  
  
  CONCLUSIONS
  The new nonocclusive coronary connector is easy to use, and the long-term results suggest favorable healing and remodeling in the porcine model. After downsizing, this anastomotic device, with its emphasis on zero ischemia and simplified prebounding of vessel walls, has intrinsic potential for minimally invasive off-pump coronary artery bypass surgery.
authors.affiliation: Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: dsteche2@umcutrecht.nl.
authors.forename: David
authors.initials: D
authors.lastname: Stecher
authors.affiliation: Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Frebus J
authors.initials: FJ
authors.lastname: van Slochteren
authors.affiliation: Department of Experimental Cardiology, Heart and Lungs Division, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Imo E
authors.initials: IE
authors.lastname: Hoefer
authors.affiliation: Department of Experimental Cardiology, Heart and Lungs Division, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Gerard
authors.initials: G
authors.lastname: Pasterkamp
authors.affiliation: Department of Neurosurgery, Brain Division, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Cornelis A F
authors.initials: CA
authors.lastname: Tulleken
authors.affiliation: Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Lex A
authors.initials: LA
authors.lastname: van Herwerden
authors.affiliation: Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Marc P
authors.initials: MP
authors.lastname: Buijsrogge
mesh_terms: D000714:Anastomosis, Surgical / Q000295:instrumentation; D000818:Animals; D001012:Aorta, Abdominal / Q000601:surgery*; D047549:Coronary Artery Bypass, Off-Pump; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D053685:Laser Therapy / Q000295:instrumentation*; D054018:Lasers, Excimer; D023421:Models, Animal; D011817:Rabbits; D013552:Swine