Blood Flow Pattern and Anastomotic Compliance for Interrupted versus Continuous Coronary Bypass Grafts
Background: Use of the interrupted coronary anastomosis has largely been abandoned in favor of the more rapid continuous suturing technique. The Coalescent U-CLIP anastomotic device allows the surgeon to create an interrupted distal anastomosis in the same amount of time that it would take to create a continuous anastomosis. This acute bovine study examined the effect of the anastomotic technique on blood flow and vessel wall function.
Methods: End-to-side coronary anastomoses were created in an open chest bovine model using the left and right internal thoracic arteries and the left anterior descending coronary artery. All other variables except suturing technique were carefully controlled. In each animal, one anastomosis was completed using a continuous suturing technique and the other was performed in an interrupted fashion using the Coalescent U-CLIP anastomotic device. Volumetric flow curves through each graft were analyzed using key indicators of anastomotic quality, and anastomotic compliance was evaluated using intravascular ultrasound. Luminal castings were created of each vessel to examine the interior surface of each anastomosis for constrictions and deformities.
Results: The interrupted anastomoses created with the Coalescent U-CLIP anastomotic device showed significant differences with respect to anastomotic compliance, pulsatility index, peak flow, and percentage of diastolic flow. The cross-sectional area and degree of luminal deformity were also different for the two suturing techniques.
Conclusions: In this acute bovine model, interrupted coronary anastomoses demonstrated superior geometric consistency and greater physiologic compliance than did continuously sutured anastomoses. The interrupted anastomosis also caused fewer disturbances to the flow waveform, behaving similarly to a normal vessel wall. The combination of these effects may influence both acute and long-term patency of the coronary bypass grafts.
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