Buijsrogge Marc P, Scheltes Jules S, Heikens Martijn, Gründeman Paul F, Pistecky Peter V, Borst Cornelius
Heart Lung Center Utrecht, University Medical Center Utrecht, The Netherlands.
J Thorac Cardiovasc Surg. 2002 Apr;123(4):788-94. doi: 10.1067/mtc.2002.120336.
In the search for a facilitated coronary artery anastomosis, we assessed the feasibility of a hybrid anastomosis technique that used a prototype anastomotic device with an extraluminal frame (crinoline-like) and octyl-cyanoacrylate adhesive.
During off-pump coronary artery bypass grafting in pigs (n = 8), a left internal thoracic artery-right coronary artery anastomosis was constructed and evaluated during the operation and at 5 postoperative weeks. The anastomosis was examined by flow measurement, angiography, intraluminal cast geometric analysis, and histologic analysis.
Anastomosis construction required 6.2 +/- 1.3 minutes (mean +/- SD). At 5 weeks all anastomoses were fully patent, with minor anastomotic diameter narrowing (median 16%, 15th-85th percentile 16%-26%). After 30-second graft occlusion, median peak hyperemic flow response was 5.0 (15th-85th percentile 4.4-6.5). As a result of complete, streamlining filling of anastomotic wall recesses by neointima formation, more intimal hyperplasia was found in the crinoline-adhesive anastomoses than in sutured control anastomoses. No excessive, lumen-narrowing neointima formation was observed, however.
The hybrid coronary anastomosis technique was feasible without any need for dedicated application tools. If technical improvements can be realized, the hybrid technique may provide an alternative to manual suturing.
为寻求一种更简便的冠状动脉吻合方法，我们评估了一种混合吻合技术的可行性，该技术使用带有腔外框架（类似裙衬）的原型吻合装置和氰基丙烯酸正辛酯粘合剂。
在猪（n = 8）的非体外循环冠状动脉旁路移植术中，构建左胸廓内动脉-右冠状动脉吻合，并在手术期间和术后5周进行评估。通过流量测量、血管造影、腔内铸型几何分析和组织学分析对吻合口进行检查。
吻合口构建需要6.2±1.3分钟（平均值±标准差）。5周时，所有吻合口均完全通畅，吻合口直径略有缩小（中位数16%，第15-85百分位数16%-26%）。在移植物闭塞30秒后，中位数峰值充血流量反应为5.0（第15-85百分位数4.4-6.5）。由于新生内膜形成使吻合壁凹陷完全、流线型填充，与缝合对照吻合口相比，裙衬-粘合剂吻合口中发现更多的内膜增生。然而，未观察到过度的、使管腔狭窄的新生内膜形成。
混合冠状动脉吻合技术是可行的，无需任何专用应用工具。如果能够实现技术改进，该混合技术可能为手工缝合提供一种替代方法。
