title: Total Arterial Minimally Invasive Direct Coronary Artery Bypass Surgery Facilitated by the Trinity Clip Connector.
abstract: OBJECTIVE
  This pilot study evaluated the feasibility of total arterial minimally invasive direct coronary artery bypass surgery by using the Trinity Clip anastomotic connector in an acute porcine model.
  
  
  METHODS
  In 3 pigs, the left and right internal thoracic arteries (LITA and RITA) were harvested conventionally and the chest closed subsequently. After a left lateral thoracotomy, the coronary target was positioned and stabilized by an endo-starfish and octopus. A free RITA-to-LITA y-graft, with a LITA-to-left anterior descending coronary artery (LAD) and a free RITA-to-obtuse marginal or posterolateral or posterior descending artery, was constructed using the Trinity Clip. Patency was assessed with angiography (n = 3 anastomoses).
  
  
  RESULTS
  The anastomotic procedure was feasible via a small lateral thoracotomy, with a fast construction of the y-graft, and successful application of the mounted complex (ie, graft, connector, and laser, temporarily fixated by a fixation clip) onto the LAD. Access to the obtuse marginal artery, posterolateral artery, and posterior descending artery was possible, with successful construction, resulting in patent anastomoses.
  
  
  CONCLUSIONS
  This experimental pilot study demonstrates the feasibility of the anastomotic technique in a total arterial minimally invasive direct coronary artery bypass approach. Revascularization of the anterior, lateral, and inferoposterior regions of the heart is possible. However, visibility during the introduction of the connector was limited, and videoscopic assistance is essential to allow for successful construction. The anastomotic technique has potential to facilitate minimally invasive coronary bypass surgery.
authors.affiliation: From the *Department of Cardiothoracic Surgery, Heart and Lungs Division, University Medical Center Utrecht, Utrecht, The Netherlands; †Corvasco Medical, Utrecht, The Netherlands; and ‡Experimental Cardiology, Heart and Lungs Division, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: David
authors.initials: D
authors.lastname: Stecher
authors.forename: Glenn
authors.initials: G
authors.lastname: Bronkers
authors.forename: Imo E
authors.initials: IE
authors.lastname: Hoefer
authors.forename: Gerard
authors.initials: G
authors.lastname: Pasterkamp
authors.forename: Marc P
authors.initials: MP
authors.lastname: Buijsrogge
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods*; D000818:Animals; D017023:Coronary Angiography / Q000379:methods; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods*; D005260:Female; D008323:Mammary Arteries / Q000601:surgery; D019060:Minimally Invasive Surgical Procedures / Q000379:methods* / Q000662:veterinary; D008962:Models, Theoretical; D010865:Pilot Projects; D013525:Surgical Instruments; D013552:Swine; D014654:Vascular Patency