Stecher David, Bronkers Glenn, Hoefer Imo E, Pasterkamp Gerard, Buijsrogge Marc P
From the *Department of Cardiothoracic Surgery, Heart and Lungs Division, University Medical Center Utrecht, Utrecht, The Netherlands; †Corvasco Medical, Utrecht, The Netherlands; and ‡Experimental Cardiology, Heart and Lungs Division, University Medical Center Utrecht, Utrecht, The Netherlands.
Innovations (Phila). 2015 Nov-Dec;10(6):389-93. doi: 10.1097/IMI.0000000000000219.
This pilot study evaluated the feasibility of total arterial minimally invasive direct coronary artery bypass surgery by using the Trinity Clip anastomotic connector in an acute porcine model.
In 3 pigs, the left and right internal thoracic arteries (LITA and RITA) were harvested conventionally and the chest closed subsequently. After a left lateral thoracotomy, the coronary target was positioned and stabilized by an endo-starfish and octopus. A free RITA-to-LITA y-graft, with a LITA-to-left anterior descending coronary artery (LAD) and a free RITA-to-obtuse marginal or posterolateral or posterior descending artery, was constructed using the Trinity Clip. Patency was assessed with angiography (n = 3 anastomoses).
The anastomotic procedure was feasible via a small lateral thoracotomy, with a fast construction of the y-graft, and successful application of the mounted complex (ie, graft, connector, and laser, temporarily fixated by a fixation clip) onto the LAD. Access to the obtuse marginal artery, posterolateral artery, and posterior descending artery was possible, with successful construction, resulting in patent anastomoses.
This experimental pilot study demonstrates the feasibility of the anastomotic technique in a total arterial minimally invasive direct coronary artery bypass approach. Revascularization of the anterior, lateral, and inferoposterior regions of the heart is possible. However, visibility during the introduction of the connector was limited, and videoscopic assistance is essential to allow for successful construction. The anastomotic technique has potential to facilitate minimally invasive coronary bypass surgery.
本前瞻性研究评估了在急性猪模型中使用Trinity Clip吻合连接器进行全动脉微创直接冠状动脉旁路移植术的可行性。
对3头猪常规采集左、右胸廓内动脉（LITA和RITA），随后关闭胸腔。经左外侧开胸术后，通过endo-starfish和章鱼装置定位并稳定冠状动脉靶点。使用Trinity Clip构建游离的RITA至LITA Y型移植物，包括LITA至左前降支冠状动脉（LAD）以及游离的RITA至钝缘支或后外侧或后降支动脉。通过血管造影评估通畅情况（n = 3个吻合口）。
经小切口外侧开胸进行吻合操作是可行的，Y型移植物构建迅速，且能成功将组装好的复合体（即移植物、连接器和激光，通过固定夹临时固定）应用于LAD。能够进入钝缘支动脉、后外侧动脉和后降支动脉，并成功构建，吻合口通畅。
本实验性前瞻性研究证明了在全动脉微创直接冠状动脉旁路移植术中吻合技术的可行性。心脏前、外侧和下后区域的血运重建是可行的。然而，引入连接器时的视野受限，视频辅助对于成功构建至关重要。该吻合技术有潜力促进微创冠状动脉旁路移植手术。
