Pabittei Dara R, Heger Michal, Simonet Marc, van Tuijl Sjoerd, van der Wal Allard C, van Bavel Ed, Balm Ron, de Mol Bas A J M
Department of Cardio -thoracic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
J Clin Transl Res. 2015 Jun 21;1(1):31-45. eCollection 2015 Jul 20.
Liquid solder laser-assisted vascular welding using biocompatible polymeric scaffolds (ssLAVW) is a novel technique for vascular anastomoses. Although ssLAVW has pronounced advantages over conventional suturing, drawbacks include low welding strength and extensive thermal damage.
To determine optimal ssLAVW parameters for maximum welding strength and minimal thermal damage.
Substudy 1 compared breaking strength (BS) of aortic strips welded with electrospun poly(ε-caprolactone) (PCL) or poly(lactic-co-glycolic acid) (PLGA) scaffold, 670-nm laser, 50-s single-spot continuous lasing (SSCL), and semi-solid solder (48% bovine serum albumin (BSA)/0.5% methylene blue (MB)/3% hydroxypropylmethylcellulose (HPMC)). Substudy 2 compared the semi-solid solder to 48% BSA/0.5% MB/0.38% genipin and 48% BSA/0.5% MB/3% HPMC/0.38% genipin solder. Substudy 3 compared SSCL to single-spot pulsed lasing (SSPL).
PCL-ssLAVW yielded an acute BS of 248.0 ± 54.0 N/cm and remained stable up to 7d of hydration. PLGA-ssLAVW obtained higher acute BS (408.6 ± 78.8 N/cm) but revealed structural defects and a BS of 109.4 ± 42.6 N/cm after 14 d of hydration. The addition of HPMC and genipin improved the 14-d BS of PLGA-sLAVW (223.9 ± 19.1 N/cm). Thermal damage was reduced with SSPL compared with SSCL.
PCL-ssLAVW yielded lower but more stable welds than PLGA-ssLAVW. The addition of HPMC and genipin to the solder increased the post-hydration BS of PLGA-ssLAVW. SSPL regimen reduced thermal damage. PLGA-ssLAVW using 48% BSA/0.5% MB/3% HPMC/0.38% genipin solder and SSPL constitutes the most optimal welding modality.
Surgical patients requiring vascular anastomoses may benefit from the advantages that ssLAVW potentially offers over conventional sutures (gold standard). These include no needle trauma and remnant suture materials in the patient, reduction of foreign body reaction, immediate liquid-tight sealing, and the possibility of a faster and easier procedure for minimally invasive and endoscopic anastomotic techniques.
使用生物相容性聚合物支架的液体焊料激光辅助血管焊接（ssLAVW）是一种用于血管吻合的新技术。尽管ssLAVW相较于传统缝合具有显著优势，但缺点包括焊接强度低和广泛的热损伤。
确定实现最大焊接强度和最小热损伤的最佳ssLAVW参数。
子研究1比较了用静电纺聚（ε-己内酯）（PCL）或聚（乳酸-共-乙醇酸）（PLGA）支架、670纳米激光、50秒单点连续激光照射（SSCL）以及半固体焊料（48%牛血清白蛋白（BSA）/0.5%亚甲蓝（MB）/3%羟丙基甲基纤维素（HPMC））焊接的主动脉条的断裂强度（BS）。子研究2将半固体焊料与48% BSA/0.5% MB/0.38%京尼平以及48% BSA/0.5% MB/3% HPMC/0.38%京尼平焊料进行比较。子研究3将SSCL与单点脉冲激光照射（SSPL）进行比较。
PCL-ssLAVW产生的急性BS为248.0±54.0 N/cm，并且在水合7天内保持稳定。PLGA-ssLAVW获得了更高的急性BS（408.6±78.8 N/cm），但在水合14天后显示出结构缺陷且BS为109.4±42.6 N/cm。添加HPMC和京尼平提高了PLGA-sLAVW的14天BS（223.9±19.1 N/cm）。与SSCL相比，SSPL减少了热损伤。
PCL-ssLAVW产生的焊缝比PLGA-ssLAVW的焊缝强度低但更稳定。在焊料中添加HPMC和京尼平增加了PLGA-ssLAVW水合后的BS。SSPL方案减少了热损伤。使用48% BSA/0.5% MB/3% HPMC/0.38%京尼平焊料和SSPL的PLGA-ssLAVW构成了最优化的焊接方式。
需要血管吻合的手术患者可能会从ssLAVW相对于传统缝合（金标准）潜在提供的优势中受益。这些优势包括无针头创伤和患者体内无残留缝合材料、减少异物反应、立即实现液密密封以及对于微创和内镜吻合技术而言有更快且更简便操作的可能性。
