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OBJECTIVE: Traditional hand sewing and knot tying have been used for coronary artery bypass grafting (CABG). Although distal suture devices have been developed to facilitate an easier anastomosis in limited cases, such as endoscopic or robotically assisted CABG, almost all these devices were withdrawn from the market for various reasons. We developed a suture for coronary artery, which eliminates knot tying after continuous suture. We examined safety, feasibility and durability of this suture in swine CABG models.
METHODS: A tiny anchoring mechanism (1.0 x 0.5 mm) made up with biocompatible stainless steel is attached to the tail of a regular 8-0 polypropylene suture (Figure). This anchor works as a stop mechanism at the start point and as a hooking mechanism at completion of a continuous anastomosis. Suture is fixed by pinching the anchoring device by a needle driver, thus eliminating knot tying. Stability of anastomosis and tissue invasiveness of this new suture were examined in an off-pump CABG model using bilateral internal thoracic artery in miniature swine (acute, 1 month, 3 months and 6 months). All animals received humane care according to the guidelines of the University of Tokyo.
RESULTS: Pigs were divided to two groups: new suture group and conventional suture group. Suture time and graft flow were not different between groups. Graft patency rate by angiography after 1 month (n = 5), 3 months (n =4) and 6 months (n = 2) was 100% in both groups. Histopathologic examination revealed only mild inflammatory responses at the anastomotic sites in both groups without any specific inflammatory change derived from the stainless steel anchor. Feasibility of this new suture is now being tested in an endoscopic situation.
CONCLUSIONS: Safety, feasibility and durability of this new suture device were shown in animal models. This may be a promising distal suture device for CABG in endoscopic and robotic assistance as well as a regular open situation.