Document Detail


A novel one-shot anastomotic stapler prototype for coronary bypass grafting on the beating heart: feasibility in the pig.
MedLine Citation:
PMID:  9869765     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: The nonpenetrating, arcuate-legged clip has proved its ability to provide a high-quality microvascular anastomosis. This study assessed the feasibility of constructing a coronary end-to-side anastomosis on the beating heart with a novel mechanical, sutureless anastomotic device that applies 12 circumferential clips simultaneously. METHODS: In 14 consecutive pigs (70-90 kg), the left internal thoracic artery (diameter, 3 mm) was grafted to the left anterior descending coronary artery (diameter, 3 mm) by means of a one-shot anastomotic stapler prototype. Endothelial denudation, medial necrosis, and intimal hyperplasia were analyzed quantitatively and compared with those seen in conventionally sutured anastomoses (n = 4). RESULTS: In 8 of 14 anastomoses, the one-shot anastomotic stapler successfully applied all 12 clips circumferentially across the everted arteriotomy edges. In the remaining, either 1 (n = 4) or 3 and 4 adjoining malaligned clips had to be replaced manually with a single-clip applicator. Coronary occlusion was limited to approximately 3 minutes. At follow-up, all anastomoses were patent angiographically. At 2 days, in 2 of 7 cases, a local coronary dissection was observed, and there was a considerable loss of endothelial cells and medial damage. At 28 days, however, minimal intimal hyperplasia was seen at the anastomotic lining, although more pronounced when compared with conventionally sutured anastomoses. CONCLUSIONS: The one-shot anastomotic stapler prototype enabled short-occlusive (3 minutes), sutureless end-to-side grafting on the beating porcine heart. In spite of early endothelial and medial damage and 2 local dissections, all anastomoses remained patent with minimal intimal hyperplasia at 4 weeks.
Authors:
R H Heijmen; P Hinchliffe; C Borst; C W Verlaan; C M Mouës; Y J van der Helm; S Manzo; E W Jansen; P F Gründeman
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  117     ISSN:  0022-5223     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  1999 Jan 
Date Detail:
Created Date:  1999-01-28     Completed Date:  1999-01-28     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  117-25     Citation Subset:  AIM; IM    
Affiliation:
Departments of Cardiology and Cardiothoracic Surgery, Heart Lung Institute, Utrecht University Hospital, Utrecht, The Netherlands.
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MeSH Terms
Descriptor/Qualifier:
Anastomosis, Surgical / instrumentation
Animals
Coronary Artery Bypass / instrumentation*
Coronary Vessels / pathology,  surgery*
Equipment Design
Feasibility Studies
Hyperplasia / pathology
Surgical Stapling*
Swine
Tunica Intima / pathology

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


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