Heijmen R H, Borst C, van Dalen R, Verlaan C W, Mouës C M, van der Helm Y J, Gründeman P F
Department of Cardiology, Utrecht University Hospital, The Netherlands.
Ann Thorac Surg. 1998 Aug;66(2):471-6. doi: 10.1016/s0003-4975(98)00449-4.
This study assessed the feasibility of applying a temporary luminal arteriotomy seal during end-to-side coronary artery bypass grafting on the beating heart.
In 18 consecutive pigs, the left internal mammary artery was grafted to the left anterior descending coronary artery, and the arteriotomy was temporarily sealed luminally by a 200-microm-thick polyurethane seal. Endothelial denudation, medial necrosis, and intimal hyperplasia were measured quantitatively and compared with conventionally sutured anastomoses (n=4 pigs).
Insertion and retrieval of the seal required 28+/-12 and 11+/-6 seconds, respectively. Including the arteriotomy, coronary artery occlusion was limited to about 80 seconds. The seal provided a bloodless arteriotomy in all anastomoses with unimpeded coronary artery blood flow. Endothelial denudation was limited to two thirds of the circumference of the coronary artery. No medial necrosis was found. Intimal hyperplasia at the suture line was small, although more pronounced when compared with conventionally sutured anastomoses.
In off-pump, beating-heart coronary artery bypass grafting, the temporary luminal arteriotomy seal provided a bloodless arteriotomy with negligible obstruction to coronary artery blood flow, and with a minimum of arterial wall damage. It is conceivable that this seal may expand the indications for coronary surgical procedures without cardiopulmonary bypass.
本研究评估了在心脏跳动时进行端侧冠状动脉搭桥术中应用临时性腔内动脉切开封堵术的可行性。
对18只连续的猪，将左乳内动脉移植至左前降支冠状动脉，并通过一个200微米厚的聚氨酯封堵物临时性腔内封堵动脉切开处。对内皮剥脱、中层坏死和内膜增生进行定量测量，并与传统缝合吻合术（4只猪）进行比较。
封堵物的置入和取出分别需要28±12秒和11±6秒。包括动脉切开在内，冠状动脉阻断时间限制在约80秒。封堵物在所有吻合处均提供了无血的动脉切开，冠状动脉血流不受阻碍。内皮剥脱局限于冠状动脉周长的三分之二。未发现中层坏死。缝合线处的内膜增生较小，尽管与传统缝合吻合术相比更明显。
在非体外循环心脏跳动冠状动脉搭桥术中，临时性腔内动脉切开封堵术提供了无血的动脉切开，对冠状动脉血流的阻碍可忽略不计，且对动脉壁的损伤最小。可以想象，这种封堵物可能会扩大非体外循环冠状动脉手术的适应证。
