Nazari S, Luzzana F, Banfi C, Mourad Z, Salvi S, Gaspari A, Nazari-Coerezza F
Department of Surgery, IRCCS San Matteo, University of Pavia, Italy.
Eur J Cardiothorac Surg. 1996;10(11):1003-9. doi: 10.1016/s1010-7940(96)80404-0.
Most complications of descending aorta prosthetic substitution seem mainly to be related directly (ischemia to distal organs, i.e. liver, kidney, spinal cord) or indirectly (extracorporeal circulation or shunts and systemic heparinization complications) to the duration of blood flow interruption. the purpose of this study is to report the results of animal experimentation of a new device for sutureless prosthetic substitution of the descending thoracic aorta, with a very short cross-clamping phase.
The device consists of expandable loops of stainless steel wires, sewn to the proximal end of a Dacron prosthesis. The stainless steel wire loops can be expanded and tightened by activating a removable guide in such a way that the prosthesis varies its diameter, while maintaining a regular cylindrical shape. The device was prepared in two different configurations, one for long segments (expandable prosthesis end) and the other to be used for very short segments or as an anastomotic ring between prosthetic or vascular stumps (quick anastomotic ring). The expandable prosthesis end was tested in swine experiments by performing the prosthetic substitution of the first 10 cm of descending cross-clamped aorta, the prosthesis being fixed with the device both at the proximal and the distal ends (six experiments). All animals survived the procedure, that was accomplished with a very short cross-clamping time. The quick anastomotic ring was used to anastomose two prosthesis ends, at the middle of the prosthetic segment used for descending aorta substitution (two swine), to perform the distal anastomosis in the same model of descending aorta substitution (one swine) and simply to re-anastomose a subtotally transected descending aorta (one swine).
The present experience proved the reliability of the device to carry out a sutureless, accurate, simple and quick anastomosis. Its advantage over an intraluminal ringed prosthesis is much easier insertion of the retracted wired end into the vascular stumps, thus allowing for a prosthetic diameter appropriate to the substituted vessel.
The reduced cross-clamping feature of the device would suggest its use mainly in thoracic aorta prosthetic substitution for the prevention of ischemic damage to distal organs; it can also be used to advantage wherever an end-to-end vascular or prosthetic anastomosis is indicated, providing an accurate, stented anastomosis.
降主动脉人工血管置换术的大多数并发症似乎主要直接（对远端器官如肝脏、肾脏、脊髓的缺血）或间接（体外循环或分流及全身肝素化并发症）与血流阻断时间有关。本研究的目的是报告一种用于胸降主动脉无缝合人工血管置换的新装置的动物实验结果，该装置具有非常短的阻断期。
该装置由缝在涤纶人工血管近端的不锈钢丝可扩张环组成。通过激活一个可移除的导向器，不锈钢丝环可扩张并收紧，使人工血管改变其直径，同时保持规则的圆柱形。该装置有两种不同的构型，一种用于长节段（可扩张人工血管端），另一种用于非常短的节段或用作人工血管或血管残端之间的吻合环（快速吻合环）。可扩张人工血管端在猪实验中进行测试，通过对胸降主动脉阻断的前10cm进行人工血管置换，人工血管在近端和远端均用该装置固定（6次实验）。所有动物均在手术过程中存活，且手术在非常短的阻断时间内完成。快速吻合环用于在降主动脉置换所用人工血管节段的中间吻合两个人工血管端（2头猪），在同一降主动脉置换模型中进行远端吻合（1头猪），以及简单地重新吻合完全横断的降主动脉（1头猪）。
目前的经验证明了该装置进行无缝合、准确、简单和快速吻合的可靠性。与腔内带环人工血管相比，其优点是缩回的有线端更容易插入血管残端，从而使人工血管直径适合被置换的血管。
该装置减少阻断的特点表明其主要用于胸主动脉人工血管置换以预防对远端器官的缺血性损伤；在需要端端血管或人工血管吻合的任何情况下，它也可发挥优势，提供准确的带支架吻合。
