Lisi G, Perrault L P, Menasché P, Bel A, Wassef M, Vilaine J P, Vanhoutte P M
Department of Cardiovascular Surgery, Hôpital Lariboisière, Paris, France.
Ann Thorac Surg. 1998 Nov;66(5):1705-8. doi: 10.1016/s0003-4975(98)00912-6.
The safe development of minimally invasive coronary artery bypass operations might require alternatives to conventional suture-based anastomotic techniques. In this setting, nonpenetrating stapling is an attractive option because of its simplicity of use and potential for improved endothelial preservation.
In the experimental part of this study, porcine internal mammary arteries were anastomosed to left anterior descending coronary arteries using either an 8-0 polypropylene running suture or nonpenetrating microclips (7 anastomoses in each group). The endothelium-dependent relaxations to bradykinin of the arterial rings bearing the anastomosis and of noninstrumented rings were compared in organ chamber experiments. There were no significant differences in maximal relaxations (mean +/- SEM) between the microclipped and sutured anastomoses (81%+/-7% versus 74%+/-10%), which were both significantly lower than those of control coronary rings (98%+/-2%, p = 0.001 versus the two anastomosed groups). Histologic examination showed a comparable preservation of the coronary and graft endothelium with both techniques. The clinical part of the study comprised 7 patients in whom the left internal mammary artery was conventionally sutured to the left anterior descending whereas 13 saphenous vein grafts were anastomosed to their target vessels by nonpenetrating staples. There were no clip-related complications. An angiographic assessment of the venous grafts was performed within 10 days postoperatively in all patients. One graft is presumably occluded. The 12 remaining conduits were patent with stapled anastomoses featuring a widely open "shark-mouth" configuration.
These preliminary data suggest that non-penetrating stapling is an easy-to-use technique that competes well with conventional suturing, at least in terms of immediate results. Further studies are warranted to better define its potential place within the armamentarium of minimally invasive coronary artery bypass techniques.
微创冠状动脉搭桥手术的安全开展可能需要传统缝线吻合技术的替代方法。在此背景下，非穿透性吻合器因其使用简便且可能改善内皮保护而成为一个有吸引力的选择。
在本研究的实验部分，使用8-0聚丙烯连续缝线或非穿透性微型吻合夹将猪的胸廓内动脉与左前降支冠状动脉进行吻合（每组7例吻合）。在器官浴槽实验中，比较了带有吻合口的动脉环和未处理动脉环对缓激肽的内皮依赖性舒张反应。微型吻合夹吻合组和缝线吻合组的最大舒张反应（均值±标准误）无显著差异（分别为81%±7%和74%±10%），两者均显著低于对照冠状动脉环（98%±2%，与两组吻合组相比，p = 0.001）。组织学检查显示两种技术对冠状动脉和移植物内皮的保护相当。本研究的临床部分包括7例患者，其中左胸廓内动脉采用传统方法缝合至左前降支，而13条大隐静脉移植物通过非穿透性吻合器与目标血管进行吻合。未出现与吻合夹相关的并发症。所有患者在术后10天内对静脉移植物进行了血管造影评估。1条移植物可能闭塞。其余12条血管通路通畅，吻合器吻合处呈现宽阔开放的“鲨鱼嘴”形态。
这些初步数据表明，非穿透性吻合器技术是一种易于使用的技术，至少在即刻结果方面与传统缝合技术相当。有必要进行进一步研究，以更好地确定其在微创冠状动脉搭桥技术中的潜在地位。
