Application of a New Suture Material Called the U-Clip for Composite and Sequential Grafting with Off-Pump Coronary Bypass Surgery

Authors

  • Noritsugu Morishige
  • Yoshio Hayashida
  • Nobuhisa Ito
  • Hideki Teshima
  • Kazuma Takeuchi
  • Hidehiko Iwahashi
  • Tadashi Tashiro

DOI:

https://doi.org/10.1532/HSF98.20061084

Abstract

Background. The U-Clip was found to facilitate the interrupted anastomosis of coronary artery bypass grafts (CABG). This device may be beneficial especially in multivessel off-pump CABG (OPCAB) using composite grafts or sequential anastomosis. The aim of this study was to evaluate our early clinical experience using the U-Clip in OPCAB cases.

Methods. This retrospective study included 118 patients who underwent off-pump CABG between 2001 and 2004. The mean age of the 91 men and 27 women was 69.5 ± 8.0 years (range, 47-85). The U-Clip was adopted for sewing 73 proximal ends of the free graft to the side or end of the inflow conduit to prepare the composite graft. The U-Clip was also applied to 112 distal anastomoses, especially to the side-to-side anastomosis of the sequential graft.

Results. Hospital mortality rate was 0.8% (1/118). The early patency rate of distal anastomoses using the U-Clip was 95% (96/101). The early patency rate of proximal anastomoses using the U-Clip was 98.4% (62/63). Interim angiography was performed in 12 patients (range, 3.8-42 months; average, 16 months). In these 12 patients, a total of 8 proximal anastomoses of conduits using the U-Clip were all patent without stenosis. The patency rate of a total of 10 distal anastomoses in the 12 patients using the U-Clip was 100%.

Conclusions. The U-Clip-interrupted anastomosis enables a safe, definite, and rapid end-to-end or end-to-side connection of arterial grafts. We therefore consider the U-Clip to be a useful suture material especially for multivessel OPCAB using multiple arterial grafts.

References

Ballyk PD, Walsh C, Butany J, Ojha M. 1998. Compliance mismatch may promote graft-artery intimal hyperplasia by altering suture-line stresses. J Biomech 31:229-37.nCalafiore AM, Teodori G, Di Giammarco G, et al. 1999. Multiple arterial conduits without cardiopulmonary bypass: early angiographic results. Ann Thorac Surg 67;450-6.nCaskey MP, Kirshner MS, Alderman EL, et al. 2002. Six-month angiographic evaluation of beating-heart coronary arterial graft interrupted anastomosis using the coalescent U-CLIP anastomotic device: a prospective clinical study. Heart Surg Forum 5:319-26.nDemaria RG, Fortier S, Malo O, et al. 2003. Interrupted coalescent nitinol clip versus continuous suture coronary anastomosis: a comparative endothelial function study. Heart Surg Forum 6:72-76.nFitzGibbon GM, Kafka HP, Leach AJ. 1996. Coronary bypass graft fate and patient outcome: angiographic follow-up of 5,065 grafts related to survival and reoperation in 1,388 patients during 25 years. J Am Coll Cardiol 28:616-26.nGerdisch M, Hinkamp T, Stephen D, et al. 2002. Blood flow pattern and anastomotic compliance for interrupted versus continuous coronary bypass graft. Heart Surg Forum 6:65-71.nGuidoin R, Doyon B, Blais P, et al. 1981. Effects of traumatic manipulations on grafts, sutures, and host arteries during vascular surgery procedures. Experiments on dogs. Res Exp Med (Berl) 179:1-21.nHill AC, Maroney TP, Virmani R. 2001. Facilitated coronary anastomosis using a nitinol U-clip device: bovine model. J Thorac Cardiovasc Surg 121:859-70.nKahn NE, De Souza A, Mister R, et al. 2004. A randomized comparison of off-pump and on-pump multivessel coronary artery bypass surgery. N Engl J Med 350:21-8.nKobayashi J, Tashiro T, Ochi M, et al. 2005. Early outcome of a randomized comparison of off-pump and on-pump multiple arterial coronary revascularization. Circulation 112;338-43.nLoop FD. 1979. Technique for performance of internal mammary artery-coronary artery anastomosis. J Thorac Cardiovasc Surg 78:460-3.nLoop FD, Lyte BW, Cosgrove DM, et al. 1986. Influence of the internal mammary artery graft on 10-year survival and other cardiac events. N Engl J Med 314:1-6.nLowe HC, Oesterle SN, Khachigian LM. 2002. Coronary in-stent restenosis: current status and future strategies. J Am Coll Cardiol 39:183-93.nOno M, Wolf RK, Angouras D, Schneeberger EW. 2002. Early experience of coronary artery bypass grafting with a new self-closing clip device. J Thorac Cardiovasc Surg 123:783-7.nParolari A, Alamanni F, Polvani G, et al. 2005. Meta-analysis of randomized trials comparing off-pump with on-pump coronary artery bypass graft patency. Ann Thorac Surg 80:2121-5.nPukas JD, Thourani VH, Marshall JJ, et al. 2001. Clinical outcomes, angiographic patency, and resource utilization in 200 consecutive off-pump coronary bypass patients. Ann Thorac Surg 71;1477-83.nPukas JD, Cheng D, Knight J, et al. 2005. Off-pump versus conventional coronary artery bypass grafting a meta-analysis and consensus statement from the 2004 ISMICS consensus conference. Innovations 1:3-27.nTepe G, Schmehl J, Wendel HP, et al. 2006. Reduced thrombogenicity of nitinol stents—in vitro evaluation of different surface modifications and coating. Biomaterials 27:643-50.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 19:477-81nWolf RE, 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 126:168-78.n

Published

2006-10-09

How to Cite

Morishige, N., Hayashida, Y., Ito, N., Teshima, H., Takeuchi, K., Iwahashi, H., & Tashiro, T. (2006). Application of a New Suture Material Called the U-Clip for Composite and Sequential Grafting with Off-Pump Coronary Bypass Surgery. The Heart Surgery Forum, 9(6), E861-E865. https://doi.org/10.1532/HSF98.20061084

Issue

Section

Articles

Most read articles by the same author(s)