A Laser-Assisted Anastomotic Technique - Feasibility on Human Diseased Coronary Arteries
David Stecher, Aryan Vink, Gerard Pasterkamp, Marc P. Buijsrogge.
University Medical Center Utrecht, Utrecht, Netherlands.
OBJECTIVE: Atherosclerotic disease might hamper efficacy of the Excimer laser-assisted Trinity Clip anastomotic connector in coronary arteries. Therefore, its efficacy was evaluated on human diseased coronary arteries (study 1). Additionally, the acute laser effects onto the coronary wall were assessed (study 2).
METHODS: Thirty-eight anastomoses were constructed on ex vivo human hearts. Atherosclerosis was histo-pathologically determined and subsequently related to the success of the technique (ie, connector positioning and laser-punching; study 1). Additionally, 20 anastomoses were constructed in an ex vivo (porcine, n=8) and in vivo (rabbit [n=9] and porcine [n=3]) model. Subsequently, the coronary artery was histologically studied on the presence of laser-induced damage (study 2).
RESULTS: In 13 of 38 anastomoses (study 1), the connector was mal-positioned; 3 due to a severely diseased coronary wall and 10 due to an inner diameter below the intended target range. The laser-punch success rate on coronaries with an early lesion was 100% (16/16) and 89% (8/9) in advanced lesions, which were mainly located in the inferolateral wall (Figure A; asterisks indicates laser-punched arteriotomy); in 1 of 9 anastomoses the lesion was located in the superior wall and caused a laser-punch failure (Figure B: incompletely laser-punched wall [arrow]). No histological signs of laser-induced damage were observed, in case of correct use (study 2).
CONCLUSIONS: This study demonstrates the feasibility of an anastomotic connector on human diseased coronary arteries and shows that lasering does not induce coronary wall damage. However, careful selection of the coronary artery, regarding the inner target diameter and disease status, will prevent construction failures. This connector could facilitate less invasive CABG.
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