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J Thorac Cardiovasc Surg 2003;125:385-390
© 2003 The American Association for Thoracic Surgery

Evolving Technology (ET)

Briefly occlusive coronary anastomosis with tissue adhesive

Marc P. Buijsrogge, MD, Cees W. J. Verlaan, Paul F. Gründeman, MD, PhD, Cornelius Borst, MD, PhD

From the Heart Lung Center Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands.

Received for publication Jan 29, 2002. Revisions requested April 24, 2002; revisions received May 21, 2002. Accepted for publication July 30, 2002. Address for reprints: Paul F. Gründeman, MD, PhD, Associate Professor of Experimental Cardiothoracic Surgery, University Medical Center Utrecht (Room G02.523), Heart Lung Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands (E-mail: exp.cardio{at}hli.azu.nl).

Objective: We assessed the feasibility of a facilitated, briefly occlusive, sutureless coronary anastomosis technique in which side-to-side preglued (octylcyanoacrylate adhesive) bounded walls were opened by a conventional arteriotomy.
Methods: In low-flow (prothrombotic milieu, <=15 mL/min, n = 8) and high-flow (approximately 50 mL/min, n = 8) porcine model of off-pump internal thoracic artery-left anterior descending coronary artery bypass, the anastomoses were evaluated intraoperatively (n = 16) and at 5 weeks (n = 14, with 2 evaluated at 2.5 weeks). The anastomoses were examined by flow measurement, angiography, and histologic studies.
Results: Coronary occlusion lasted a median of 1.6 minutes (15th-85th percentile 1.4-1.8 minutes), and anastomosis construction required a median of 5.5 minutes (15th-85th percentile 4.2-6.5 minutes). At 5 weeks all anastomoses were fully patent (FitzGibbon grade A), with an angiographic appearance similar to an end-to-side anastomotic configuration.
Conclusions: The briefly occlusive adhesive anastomosis technique proved to be feasible in off-pump bypass surgery in the pig even under prothrombotic low bypass graft flow conditions (<=15 mL/min). Further studies are warranted to investigate the applicability of this technique to endoscopic bypass surgery on the beating heart.




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