International Society for Minimally Invasive Cardiothoracic Surgery

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Early In-human Clinical Use Of Anastomotic Pedestal For Coronary Artery Bypass Grafting
Ariana Goodman1, Shaelyn Cavanaugh1, Kyle Purrman2, Jude Sauer2, Peter Knight1, Bartholomew Simon1.
1University of Rochester Strong Memorial Hospital, Rochester, NY, USA, 2LSI SOLUTIONS®, Victor, NY, USA.

BACKGROUND: Current techniques for sternal-sparing coronary revascularization often involve positioning a mobile graft away from a beating heart. Graft stabilization, suture management, and exposure become increasingly difficult in less invasive approaches. Furthermore, the small working space creates difficulties for both surgeon and assistant to ergonomically complete an anastomosis. A novel graft stabilization pedestal was designed to address these challenges. This technology has been tested in pre-clinical evaluations and is now available for clinical use. Herein, we present our early clinical experience using the device in an open CABG procedure.
METHODS: A 51-year-old female presented with an anterior myocardial infarction and was found to have severe three vessel coronary disease. She was brought to the operating room for surgical revascularization where a sternotomy was performed, and the left internal thoracic artery (LITA) was harvested in skeletonized fashion. The patient was placed on cardiopulmonary bypass and the heart was arrested. After completion of a saphenous vein to obtuse marginal anastomosis, the novel graft stabilization pedestal was secured to a table-mounted retractor system with a task-specific adaptor (Figure 1). The previously exposed LITA was placed onto the pedestal and held with a soft retainer. The pedestal was adjusted such that the distal end of the LITA graft was positioned directly adjacent to the left anterior descending artery target. An 8-0 polypropylene suture was placed through the suture slots, maintaining appropriate tension, and managing suture without an assistant. The anastomosis was secured with a titanium fastener.
RESULTS: The anastomosis was completed in a timely manner and resulted in a successful graft placement with no evidence of dissection or kinking. Flow through the graft was excellent, measuring over 100 mL/min. Surgeon satisfaction with the device was high. The patient was transferred to the ICU and extubated on post-operative day zero. CONCLUSIONS: An anastomotic pedestal was designed to facilitate less invasive coronary artery bypass. Here we present a successful early in-human clinical use of the device, displaying its usability and ability to facilitate anastomotic suturing during open coronary artery bypass. Further clinical development will include use of the device in off-pump and minimally invasive access.
LEGEND: Figure 1. A) Illustration of device B) Device during early in-human use with retractor system adaptor C) Illustration of device with anastomotic sutures between graft and coronary target D) Usage of the device intra-operatively.


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