Document Detail

Nonpenetrating stapling: a valuable alternative for coronary anastomoses?
MedLine Citation:
PMID:  9875775     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The safe development of minimally invasive coronary artery bypass operations might require alternatives to conventional suture-based anastomotic techniques. In this setting, nonpenetrating stapling is an attractive option because of its simplicity of use and potential for improved endothelial preservation. METHODS AND RESULTS: In the experimental part of this study, porcine internal mammary arteries were anastomosed to left anterior descending coronary arteries using either an 8-0 polypropylene running suture or nonpenetrating microclips (7 anastomoses in each group). The endothelium-dependent relaxations to bradykinin of the arterial rings bearing the anastomosis and of noninstrumented rings were compared in organ chamber experiments. There were no significant differences in maximal relaxations (mean +/- SEM) between the microclipped and sutured anastomoses (81%+/-7% versus 74%+/-10%), which were both significantly lower than those of control coronary rings (98%+/-2%, p = 0.001 versus the two anastomosed groups). Histologic examination showed a comparable preservation of the coronary and graft endothelium with both techniques. The clinical part of the study comprised 7 patients in whom the left internal mammary artery was conventionally sutured to the left anterior descending whereas 13 saphenous vein grafts were anastomosed to their target vessels by nonpenetrating staples. There were no clip-related complications. An angiographic assessment of the venous grafts was performed within 10 days postoperatively in all patients. One graft is presumably occluded. The 12 remaining conduits were patent with stapled anastomoses featuring a widely open "shark-mouth" configuration. CONCLUSIONS: These preliminary data suggest that non-penetrating stapling is an easy-to-use technique that competes well with conventional suturing, at least in terms of immediate results. Further studies are warranted to better define its potential place within the armamentarium of minimally invasive coronary artery bypass techniques.
G Lisi; L P Perrault; P Menasché; A Bel; M Wassef; J P Vilaine; P M Vanhoutte
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  66     ISSN:  0003-4975     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  1998 Nov 
Date Detail:
Created Date:  1999-02-03     Completed Date:  1999-02-03     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1705-8     Citation Subset:  AIM; IM    
Department of Cardiovascular Surgery, Hôpital Lariboisière, Paris, France.
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MeSH Terms
Anastomosis, Surgical / methods*
Bradykinin / pharmacology
Coronary Artery Bypass / methods*
Coronary Vessels / surgery
Endothelium, Vascular / physiology
Mammary Arteries / surgery*
Middle Aged
Organ Culture Techniques
Saphenous Vein / surgery*
Surgical Procedures, Minimally Invasive / methods*
Surgical Stapling / methods*
Reg. No./Substance:
Comment In:
Ann Thorac Surg. 1999 Oct;68(4):1443-4   [PMID:  10543541 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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