Stapled coronary anastomosis with minimal intraluminal artifact: The S2 Anastomotic System in the off-pump porcine model

Suyker, Willem J.L.; Buijsrogge, Marc P.; Suyker, Paul T.W.; Verlaan, Cees W.J.; Borst, Cornelius; Gründeman, Paul F.

doi:10.1016/j.jtcvs.2003.04.006

Cited by 39 publications

(25 citation statements)

References 10 publications

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“…Patients undergoing off-pump CABG but without collaterals may benefit from a number of measures such as ischemic myocardial preconditioning by short periods of repeated coronary occlusions, the use of intracoronary or aortocoronary shunting of blood, or a reduction of the coronary occlusion time by novel anastomosis techniques. [22][23][24][25][26] After preconditioning, less CK-MB release during PCI and less troponin release Kaplan-Meier estimates of proportion experiencing any event (composite of all-cause death, nonfatal stroke, nonfatal MI, and coronary reintervention) at 1 year after bypass surgery in patients with or without collaterals. Probability values were calculated with log-rank test.…”

Section: Discussionmentioning

confidence: 99%

Role of Coronary Collaterals in Off-Pump and On-Pump Coronary Bypass Surgery

Nathoe¹,

Buskens²,

Jansen³

et al. 2004

Circulation

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Background-Collaterals limit infarct size, preserve viability, and reduce mortality in patients with acute myocardial infarction. In patients with stable coronary disease, collaterals are associated with less angina and ischemia during angioplasty and fewer ischemic events during follow-up. The role of collaterals has not been studied in patients undergoing off-pump or on-pump bypass surgery. Methods and Results-The population consisted of the 281 patients randomized to off-pump or on-pump CABG in the Octopus Study. Collaterals were defined on the baseline angiogram with the Rentrop score and were present in 49% and 51% of the patients in the off-pump and on-pump group, respectively. Perioperative myocardial infarction was defined by a creatine kinase-MB to CK ratio Ͼ10% and occurred in 18.2% in the off-pump group and 32.5% in the on-pump group. The unadjusted OR of perioperative myocardial infarction in the presence of collaterals was 0.31 (95% CI 0.17 to 0.84) in the off-pump group and 1.06 (95% CI 0.29 to 3.85) in the on-pump group After adjustment for age, gender, hypertension, hypercholesterolemia, diabetes, multivessel disease, ventricular dysfunction, incomplete revascularization, and ischemic time, the OR was 0.34 (95% CI 0.14 to 0.84) in the off-pump group and 1.28 (95% CI 0.30 to 5.40) in the on-pump group, respectively. Kaplan-Meier estimates of event-free survival at 1 year were 87% in patients with and 69% in those without collaterals after off-pump CABG. These estimates were 66% and 63%, respectively, after on-pump CABG. Conclusions-Collaterals protect against perioperative myocardial infarction during off-pump surgery but not during on-pump surgery and are associated with a better 1-year event-free survival.

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Section: Discussionmentioning

confidence: 99%

Role of Coronary Collaterals in Off-Pump and On-Pump Coronary Bypass Surgery

Nathoe¹,

Buskens²,

Jansen³

et al. 2004

Circulation

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“…Currently, only 1 coronary anastomotic connector is being used clinically 17,18 , multiple other devices demonstrated unfavorable experimental or clinical results, or developers failed to market the product [19][20][21] . Compared to other methods to facilitate the coronary anastomosis, the Trinity Clip includes several interesting features.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of a Novel Laser-assisted Coronary Anastomotic Connector - the Trinity Clip - in a Porcine Off-pump Bypass Model

Stecher¹,

Bronkers²,

Noest³

et al. 2014

JoVE

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To simplify and facilitate beating heart (i.e., off-pump), minimally invasive coronary artery bypass surgery, a new coronary anastomotic connector, the Trinity Clip, is developed based on the excimer laser-assisted nonocclusive anastomosis technique. The Trinity Clip connector enables simplified, sutureless, and nonocclusive connection of the graft to the coronary artery, and an excimer laser catheter laser-punches the opening of the anastomosis. Consequently, owing to the complete nonocclusive anastomosis construction, coronary conditioning (i.e., occluding or shunting) is not necessary, in contrast to the conventional anastomotic technique, hence simplifying the off-pump bypass procedure. Prior to clinical application in coronary artery bypass grafting, the safety and quality of this novel connector will be evaluated in a long-term experimental porcine off-pump coronary artery bypass (OPCAB) study. In this paper, we describe how to evaluate the coronary anastomosis in the porcine OPCAB model using various techniques to assess its quality. Representative results are summarized and visually demonstrated.

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“…Minimally, invasive surgery has now been proven beneficial to patients both economically and medically and is accepted as the new gold standard for classified procedures. 1 Although coronary artery bypass grafting (CABG) and minimally invasive direct coronary artery bypass grafting (MIDCABG) are the most common procedures in adult cardiac surgery, 2 the current interest in achieving coronary artery bypass surgery through ever-shrinking incisions has led to the introduction of video-assisted thoracoscopy in the field of cardiac surgery, 3 with improved patient comfort and cosmetic results while decreasing local morbidity, including wound infection, dehiscence, or skin necrosis. 2 Such developments, combined with the latest trend in cardiac surgery-robotic-enhanced coronary artery bypass-and the usage of the IMA as the conduit of choice in MIDCABG surgery, have introduced the need for an experimental model in living tissue designed for training in video-assisted thoracoscopic harvesting of the IMA.…”

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Thoracoscopic approach of the internal mammary artery (IMA): A training model in pigs

Jiga

Cristian²,

Blidișel

et al. 2008

Microsurgery

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Endoscopic internal mammary artery (IMA) approach represents a well-established procedure in coronary bypass surgery. However, such techniques require highly trained skills that need to be mastered in experimental models before taken into the clinic. To attain such skills, our aim was to develop a training model of thoracoscopic approach for harvesting of the IMA in pig. Ten pigs of either sex, weighing 20-28 kg, were used. The thoracic cavity was accessed with the animal in a lateral decubit position, through two ports of 10 mm and 1 of 5 mm, inserted on the anterior and posterior axillary lines immediately below the infrascapular angle into the pleural cavity, and a 30 degrees Hopkins II telescope. The internal mammary artery (IMA) was identified and dissected from its origin in the subclavian artery until its distal part where it becomes the deep superior epigastric artery. Afterward, the arterial segment was clipped and harvested. The mean operative time was 73 min. Postoperative survival at 72 hours was 100% and 90% at 4 weeks. A mean length of 3.2 cm of IMA graft was obtained (2.8-4 cm). The pig IMA has no intercostal branches; thus, the mobilization of the vessel being greatly facilitated. The procedure has two critical steps: the proper trocar insertion and the dissection of the middle one-third of the IMA. Endoscopic-assisted IMA, harvesting in pigs, represents a useful tool for training in minimally invasive heart surgery and supports further development toward other clinical applications.

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Stapled coronary anastomosis with minimal intraluminal artifact: The S2 Anastomotic System in the off-pump porcine model

Abstract: The S2 Anastomotic System consistently created automated, fast, and reliable internal thoracic to coronary artery anastomoses on the porcine beating heart with excellent graft patency and healing characteristics at the 5-week follow-up.

Cited by 39 publications

References 10 publications

Role of Coronary Collaterals in Off-Pump and On-Pump Coronary Bypass Surgery

Role of Coronary Collaterals in Off-Pump and On-Pump Coronary Bypass Surgery

Evaluation of a Novel Laser-assisted Coronary Anastomotic Connector - the Trinity Clip - in a Porcine Off-pump Bypass Model

Thoracoscopic approach of the internal mammary artery (IMA): A training model in pigs

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