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J Thorac Cardiovasc Surg 2003;126:191-199
© 2003 The American Association for Thoracic Surgery

Evolving technology

Coronary anastomotic devices: blood-exposed non-intimal surface and coronary wall stress

^a Department of Design, Engineering, and Production, Delft University of Technology, Delft, The Netherlands
^b Heart Lung Center Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands

revisions requested July 8, 2002; revisions received July 24, 2002 Received for publication April 28, 2002; accepted for publication September 24, 2002.

^* Address for reprints: Cornelius Borst, MD, PhD, Professor of Experimental Cardiology, University Medical Center Utrecht (Room G02.523), Heart Lung Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
c.borst{at}hli.azu.nl

OBJECTIVE: This study compares the area of blood-exposed non-intimal surface in device-constructed anastomoses with the conventionally sutured anastomosis and examines the technical feasibility of 0 blood-exposed non-intimal surface anastomosis configurations.

METHODS: In the device-constructed anastomosis, blood-exposed non-intimal surface was estimated in all anastomosis configurations identified in truly new (ie, nonduplicate and nonrelated) patent applications and in anastomotic devices recently introduced by several institutions. In the sutured anastomosis, blood-exposed non-intimal surface area was estimated by analysis of previously investigated anastomoses. In 0 blood-exposed non-intimal surface anastomosis configurations, finite element modeling was used to calculate coronary wall stress.

RESULTS: By the end of 2001, 57 truly new applications for the distal coronary anastomosis had been published, categorized in 11 types of anastomosis configurations. The tissue blood-exposed non-intimal surface area (ie, non-intimal tissue surface area) ranged from 0 to 6 mm². Approximate total blood-exposed non-intimal surface areas (ie, sum of tissue blood-exposed non-intimal surface and foreign body surface area) in recent devices are 80 mm² (GraftConnector, Jomed, Helsingborg, Sweden); 33 mm² (Magnetic Vascular Positioner rings, Ventrica, Inc, Fremont, Calif); 4.3 mm² (distal connector of St Jude Medical, Inc, St Paul, Minn); and 0.3 mm² (Crinoline frame, University Medical Center Utrecht/Delft University of Technology, The Netherlands). The sutured anastomoses, in contrast, contained approximately 1.3 mm² blood-exposed non-intimal surface area. The mean peak porcine coronary wall stress in 0 blood-exposed non-intimal surface anastomosis configurations with greater than 90° arteriotomy edge eversion ranges from 0.4 to 0.8 N/mm² compared with the mean porcine coronary tear stress of 0.8 N/mm².

CONCLUSIONS: In recently introduced devices for clinical use, the total blood-exposed non-intimal surface area ranges from 4.3 to 80 mm² compared with 1.3 mm² in sutured anastomoses. The blood-exposed non-intimal surface area depends on anastomotic orifice size, wall thickness, and bonding components’ location and size. Deforming the coronary wall to most of the 0 blood-exposed non-intimal surface anastomosis configurations leads to dangerously high stress concentrations in the coronary arteriotomy corners.