Interrupted Coalescent Nitinol Clip versus Continuous Suture Coronary Anastomosis: A Comparative Endothelial Function Study

  • Roland G. Demaria
  • Simon Fortier
  • Olivier Malo
  • Michel Carrier
  • Louis P. Perrault
DOI: https://doi.org/10.1532/hsf.1058

Abstract

Background: A new penetrating stapled anastomotic system using nitinol microclips (Coalescent Surgical U-Clip) has been developed to facilitate the construction of compliant interrupted sutures for minimally invasive and robotic surgery as well as for conventional procedures. The purpose of this study was to determine the effect of nitinol U-Clips used for coronary anastomosis in the development of endothelial dysfunction, compared with conventional running sutures.

Methods: In a porcine model, both internal thoracic arteries were harvested, and the heart was removed. In a Krebs solution, 2 anastomoses were realized ex vivo between internal thoracic arteries and the left anterior descending artery. One was carried out with 12 Coalescent microclips, and the other used conventional running 7-0 polypropylene suture material (Prolene). Coronary rings on the anastomotic sites were then placed in organ chambers filled with oxygenated Krebs solution. Vascular reactivity studies were performed in standard organ chamber experiments. After the contraction of the coronary arteries in response to prostaglandin F2a, the endothelium-dependent relaxation response to bradykinin was studied. The other coronary arteries served as controls.

Results: There was no statistically significant difference among the groups (P > .05) in the amplitude of the contraction response to KCl and prostaglandin F2a. There were no statistically significant differences in endothelium-dependent relaxation response to bradykinin between the nitinol microclip group and controls, between the suture group and controls, and between the nitinol microclip and suture groups. Conclusions: Coalescent nitinol U-Clips used as anastomotic devices do not induce an endothelial dysfunction and allow a compliant anastomosis under satisfactory conditions.

References

Cook JW, Schuman ES, Standage BA, Heinl P. 2001. Patency and flow characteristics using stapled vascular anastomoses in dialysis grafts. Am J Surg 181:24-7.\nDemaria R, Lhôte F-M, Dauzat M, et al. 2000. Arterial wall compliance after diode laser assisted micro-anastomosis: a comparative study with conventional manual microanastomosis on the rabbit femoral artery. Lasers Med Sci 15:207-13.\nHeijmen RH, Hinchliffe P Borst C, et al. 1999. A novel one-shot anastomotic stapler prototype for coronary bypass grafting on the beating heart: feasibility in the pig. J Thorac Cardiovasc Surg 117:117-25.\nKomori K, Shoji T, Furuyama T, et al. 2001. Non-penetrating vascular clips anastomosis inhibited intimal thickening under poor runoff conditions in canine autogenous vein grafts. Eur J Vasc Endovasc Surg 21:241-7.\nLisi G, Perrault LP Menasché P et al. 1998. Nonpenetrating stapling: a valuable alternative for coronary anastomoses? Ann Thorac Surg 66:1705-8.\nOkuhn SP Connelly DP Calakos N, Ferrell L, Pan MX, Goldstone J. 1989. Does compliance mismatch alone cause neointimal hyperplasia? J Vasc Surg 9:35-45.\nPerrault LP, Demaria RG. 2002. Flow dynamics in ITA grafts after 10 years: invited commentary. Ann Thorac Surg 73:137.\nPfister AJ. 1997. The safety of CABG without cardiopulmonary bypass. Ann Thorac Surg 64:590-1.\nShimokawa H, Aarhus LL, Vanhoutte PM. 1987. Porcine coronary arteries with regenerated endothelium have a reduced endothelium-dependent responsiveness to aggregating platelets and serotonin. Circ Res 61:256-70.\nStewart SFC, Lyman DJ. 1992. Effects of a vascular graft/natural artery compliance mismatch on pulsatile flow. J Biomech 25:297-310.\nTozzi P Hayoz D, Ruchat P et al. 2001. Animal model to compare the effects of suture technique on cross-sectional compliance on end-to-side anastomoses. Eur J Cardiothorac Surg 19:477-81.\nVanhoutte PM, Shimokawa H. 1989. Endothelium-derived relaxing factor and coronary vasospasm. Circulation 80:1-9.\nAbbott WM, Megerman J, Hasson JE, L'Italien G, Warnock DF. 1987. Effect of compliance mismatch on vascular graft patency. J Vasc Surg 5:376-82.\nBaguneid MS, Goldner S, Fulford PE, Hamilton G, Walker MG, Seifalian AM. 2001. A comparison of para-anastomotic compliance profiles after vascular anastomosis: nonpenetrating microclips versus standard sutures. J Vasc Surg 33:812-20.\nBaird RN, Abbott WM. 1976. Pulsatile blood-flow in arterial grafts. Lancet 2:948-50.\nChavanon O, Perrault LP Menasché P Carrier M, Vanhoutte PM. 1999.\nEndothelial effects of hemostatic devices for continuous cardioplegia or minimally invasive operations: updated in 1999. Ann Thorac Surg 68:1118-20.\n
Published
2005-02-02
Issue
Vol 6 No 2 (2003)
Section
Articles

Author Disclosure & Copyright Transfer Agreement

In order to publish the original work of another person(s), The Heart Surgery Forum® must receive an acknowledgment of the Author Agreement and Copyright Transfer Statement transferring to Forum Multimedia Publishing, L.L.C., a subsidiary of Carden Jennings Publishing Co., Ltd. the exclusive rights to print and distribute the author(s) work in all media forms. Failure to check Copyright Transfer agreement box below will delay publication of the manuscript.

A current form follows:

The author(s) hereby transfer(s), assign(s), or otherwise convey(s) all copyright ownership of the manuscript submitted to Forum Multimedia Publishing, LLC (Publisher). The copyright transfer covers the exclusive rights to reproduce and distribute the article and the material contained therein throughout the world in all languages and in all media of expression now known or later developed, including but not limited to reprints, photographic reproduction, microfilm, electronic data processing (including programming, storage, and transmission to other electronic data record(s), or any other reproductions of similar nature), and translations.

However, Publisher grants back to the author(s) the following:

  1. The right to make and distribute copies of all or part of this work for use of the author(s) in teaching;
  2. The right to use, after publication in The Heart Surgery Forum, all or part of the material from this work in a book by the author(s), or in a collection of work by the author(s);
  3. The royalty-free right to make copies of this work for internal distribution within the institution/company that employs the author(s) subject to the provisions below for a work-made-for-hire;
  4. The right to use figures and tables from this work, and up to 250 words of text, for any purpose;
  5. The right to make oral presentations of material from this work.

Publisher reserves the right to grant or refuse permission to third parties to republish all or part of the article or translations thereof. To republish, such third parties must obtain written permission from the Publisher. (This is in accordance with the Copyright Statute, United States Code, Title 17. Exception: If all authors were bona fide officers or employees of the U.S. Government at the time the paper was prepared, the work is a “work of the US Government” (prepared by an officer or employee of the US Government as part of official duties), and therefore is not subject to US copyright; such exception should be indicated on signature lines. If this work was prepared under US Government contract or grant, the US Government may reproduce, royalty-free, all or portions of this work and may authorize others to do so, for official US Government purposes only, if the US Government contract or grant so requires.

I have participated in the conception and design of this work and in the writing of the manuscript and take public responsibility for it. Neither this manuscript nor one with substantially similar content under my authorship has been published, has been submitted for publication elsewhere, or will be submitted for publication elsewhere while under consideration by The Heart Surgery Forum, except as described in an attachment. I have reviewed this manuscript (original version) and approve its submission. If I am listed above as corresponding author, I will provide all authors with information regarding this manuscript and will obtain their approval before submitting any revision. I attest to the validity, accuracy, and legitimacy of the content of the manuscript and understand that Publisher assumes no responsibility for the validity, accuracy, and legitimacy of its content. I warrant that this manuscript is original with me and that I have full power to make this Agreement. I warrant that it contains no matter that is libelous or otherwise unlawful or that invades individual privacy or infringes any copyright or other proprietary right. I agree to indemnify and hold Publisher harmless of and from any claim made against Publisher that relates to or arises out of the publication of the manuscript and agree that this indemnification shall include payment of all costs and expenses relating to the defense of any such claim, including all reasonable attorney’s fees.

I warrant that I have no financial interest in the drugs, devices, or procedures described in the manuscript (except as disclosed in the attached statement).

I state that the institutional Human Subjects Committee and/or the Ethics Committee approved the clinical protocol reported in this manuscript for the use of experimental techniques, drugs, or devices in human subjects and appropriate informed consent documents were utilized.

Furthermore, I state that any and all animals used for experimental purposes received humane care in USDA registered facilities in compliance with the “Principles of Laboratory Animal Care” formulated by the National Society for Medical Research and the “Guide for the Care and Use of Laboratory Animals” prepared by the Institute of Laboratory Animal Resources and published by the National Institutes of Health (NIH Publication No. 85-23, revised 1985).

Most read articles by the same author(s)