A New Needle Driver for Minientry Coronary Artery Bypass
DOI:
https://doi.org/10.1532/HSF98.20041127Abstract
Purpose: This article describes our clinical experience with a new needle driver (Olympus, Tokyo, Japan), which we have produced to facilitate minithoracotomy or port-access coronary artery anastomosis with the running suture technique.
Methods: The needle driver is 21 cm long, weighs 38 g, and has a grip shaft 1.4 cm in diameter. The device is held like a pencil. A side lever and a revolving disk in the shaft are manipulated with the fingers; a fine needle with a 7-0/8-0 monofilament suture can be grasped/released and driven to penetrate the coronary arterial wall. This device was employed in 10 consecutive patients (8 men, 2 women, 73 ± 7.5 years old), and off-pump bypass to the left anterior descending artery was achieved using the left internal thoracic artery or vein via a minithoracotomy (4.2 ± 0.6 cm long).
Results: There was no instrument-related injury during each anastomosis. The mean sewing time per anastomosis was 12 minutes (range, 8-18 minutes). Angiography confirmed the patency of the graft in all cases.
Conclusions: Although our experience is limited, we consider the present needle driver to be a viable device for facilitating off-pump, minientry coronary artery anastomosis with the suturing technique.
References
Bolton JW, Connally JE. 2004. Results of a phase one study on robotically assisted myocardial revascularization on the beating heart. Ann Thorac Surg 78:154-8.nCarrel T, Englberger L, Keller D, Windecker S, Meier B, Eckstein F. 2004. Clinical and angiographic results after mechanical connection for distal anastomosis in coronary surgery. J Thorac Cardiovasc Surg 127:1632-40.nCasselman FP, Meco M, Dom H, Foubert L, Van Praet F, Vanermen H. 2004. Multivessel distal sutureless off-pump coronary artery bypass grafting procedure using magnetic connectors. Ann Thorac Surg 78:E38-40.nOhtsuka T, Ninomiya M, Maemura T, Takamoto S. 2003. Needle-guided mini-entry in video-assisted coronary artery bypass. Eur J Cardiothorac Surg 24:644-6.nOhtsuka T, Wolf RK, Hiratzka LF, Wurnig P, Flege JB. 1997. Thoracoscopic internal mammary artery harvest for MICABG using the harmonic scalpel. Ann Thorac Surg 63:S107-9.nWolf RK, Alderman EL, Caskey MP, et al. 2003. Clinical and six-month angiographic evaluation of coronary arterial graft interrupted anastomoses by use of a self-closing clip device: a multicenter prospective clinical trial. J Thorac Cardiovasc Surg 126:168-77.n
