title: A Laser-Assisted Anastomotic Technique: Feasibility on Human Diseased Coronary Arteries.
abstract: OBJECTIVE
  Atherosclerotic disease might hamper the efficacy of the Excimer laser-assisted Trinity Clip anastomotic connector in coronary arteries. Therefore, its efficacy was evaluated on human diseased coronary arteries (study 1). In addition, the acute laser effects onto the coronary wall were assessed (study 2).
  
  
  METHODS
  Thirty-eight anastomoses were constructed on ex vivo human hearts. Atherosclerosis was histopathologically determined and subsequently related to the success of the technique (ie, connector positioning and laser punching; study 1). In addition, 20 anastomoses were constructed in an ex vivo (porcine, n = 8) and an in vivo [rabbit (n = 9) and porcine (n = 3)] model. Subsequently, the coronary was histologically studied on the presence of laser-induced damage (study 2).
  
  
  RESULTS
  In 13 of 38 anastomoses (study 1), the connector was malpositioned, 3 because of a severely diseased coronary wall and 10 because of an inner diameter less than the intended target range. The laser-punch success rates on coronary arteries with an early and advanced lesion were 100% (16/16) and 89% (8/9; lesions were located in the inferolateral wall), respectively. In one case, an advanced lesion (ie, fibrocalcified plaque) was located in the superolateral wall and caused a laser-punch failure. No histological signs of laser-induced damage were observed, in case of correct use (study 2).
  
  
  CONCLUSIONS
  This study demonstrates the feasibility of an anastomotic connector on human diseased coronary arteries and shows that lasering does not induce coronary wall damage. However, careful selection of the coronary, regarding the target inner diameter and disease status, will prevent construction failures. This connector could facilitate less invasive coronary artery bypass grafting.
authors.affiliation: From the *Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands; †Corvasco Medical B.V., Utrecht, the Netherlands; and ‡Department of Pathology, Laboratories and Pharmacy Division, §Department of Neurosurgery, Brain Division, and ||Department of 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: Aryan
authors.initials: A
authors.lastname: Vink
authors.forename: Petra H
authors.initials: PH
authors.lastname: Homoet-van der Kraak
authors.forename: Jasper
authors.initials: J
authors.lastname: Helthuis
authors.forename: Gerard
authors.initials: G
authors.lastname: Pasterkamp
authors.forename: Marc P
authors.initials: MP
authors.lastname: Buijsrogge
mesh_terms: D000714:Anastomosis, Surgical / Q000295:instrumentation / Q000379:methods*; D000818:Animals; D001026:Coronary Artery Bypass / Q000379:methods; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods; D003324:Coronary Artery Disease / Q000601:surgery*; D003331:Coronary Vessels / Q000528:radiation effects / Q000601:surgery*; D004195:Disease Models, Animal; D005260:Female; D006801:Humans; D054018:Lasers, Excimer / Q000009:adverse effects / Q000627:therapeutic use*; D011817:Rabbits; D013552:Swine