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J Thorac Cardiovasc Surg. 2014 Apr;147(4):1390-1397.e2. doi: 10.1016/j.jtcvs.2013.07.018. Epub 2013 Aug 29.

The nonocclusive laser-assisted coronary anastomotic connector in an off-pump porcine bypass model.

Author information

1
Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: dsteche2@umcutrecht.nl.
2
Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.
3
Department of Experimental Cardiology, Heart and Lungs Division, University Medical Center Utrecht, Utrecht, The Netherlands.
4
Department of Neurosurgery, Brain Division, University Medical Center Utrecht, Utrecht, The Netherlands.
5
Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.

Abstract

OBJECTIVES:

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.

PMID:
23993317
DOI:
10.1016/j.jtcvs.2013.07.018
[Indexed for MEDLINE]
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