Heijmen R H, Hinchliffe P, Borst C, Verlaan C W, Mouës C M, van der Helm Y J, Manzo S, Jansen E W, Gründeman P F
Departments of Cardiology and Cardiothoracic Surgery, Heart Lung Institute, Utrecht University Hospital, Utrecht, The Netherlands.
J Thorac Cardiovasc Surg. 1999 Jan;117(1):117-25. doi: 10.1016/s0022-5223(99)70476-9.
The nonpenetrating, arcuate-legged clip has proved its ability to provide a high-quality microvascular anastomosis. This study assessed the feasibility of constructing a coronary end-to-side anastomosis on the beating heart with a novel mechanical, sutureless anastomotic device that applies 12 circumferential clips simultaneously.
In 14 consecutive pigs (70-90 kg), the left internal thoracic artery (diameter, 3 mm) was grafted to the left anterior descending coronary artery (diameter, 3 mm) by means of a one-shot anastomotic stapler prototype. Endothelial denudation, medial necrosis, and intimal hyperplasia were analyzed quantitatively and compared with those seen in conventionally sutured anastomoses (n = 4).
In 8 of 14 anastomoses, the one-shot anastomotic stapler successfully applied all 12 clips circumferentially across the everted arteriotomy edges. In the remaining, either 1 (n = 4) or 3 and 4 adjoining malaligned clips had to be replaced manually with a single-clip applicator. Coronary occlusion was limited to approximately 3 minutes. At follow-up, all anastomoses were patent angiographically. At 2 days, in 2 of 7 cases, a local coronary dissection was observed, and there was a considerable loss of endothelial cells and medial damage. At 28 days, however, minimal intimal hyperplasia was seen at the anastomotic lining, although more pronounced when compared with conventionally sutured anastomoses.
The one-shot anastomotic stapler prototype enabled short-occlusive (3 minutes), sutureless end-to-side grafting on the beating porcine heart. In spite of early endothelial and medial damage and 2 local dissections, all anastomoses remained patent with minimal intimal hyperplasia at 4 weeks.
非穿透性、弧形腿夹已证明其能够实现高质量的微血管吻合。本研究评估了一种新型机械性、无缝合吻合装置在跳动心脏上构建冠状动脉端侧吻合的可行性，该装置可同时应用12个环形夹。
在14头连续的猪（70 - 90千克）中，使用一次性吻合吻合器原型将左胸廓内动脉（直径3毫米）移植到左前降支冠状动脉（直径3毫米）上。对内皮剥脱、中层坏死和内膜增生进行定量分析，并与传统缝合吻合术（n = 4）所见情况进行比较。
在14例吻合中，8例中一次性吻合吻合器成功地在翻转的动脉切开边缘周围应用了所有12个夹子。其余病例中，要么有1个（n = 4），要么有3个和4个相邻的未对齐夹子必须用单夹施用器手动更换。冠状动脉闭塞时间限制在约3分钟。随访时，所有吻合在血管造影上均通畅。在2天时，7例中有2例观察到局部冠状动脉夹层，并且有相当数量的内皮细胞丢失和中层损伤。然而，在28天时，吻合内衬处可见最小程度的内膜增生，尽管与传统缝合吻合术相比更明显。
一次性吻合吻合器原型能够在跳动的猪心脏上进行短时间闭塞（3分钟）、无缝合的端侧移植。尽管有早期内皮和中层损伤以及2例局部夹层，但所有吻合在4周时均保持通畅，内膜增生最小。
