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      A different technique for sutureless coronary bypass grafting

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          Abstract

          Introduction

          Many coronary anastomotic devices have been designed to replace manual stitching in coronary surgery; however, interestingly, none of them became widespread. Our aim was to work out an easy and fast endoluminal vessel-to-vessel stent bridge distal anastomotic technique.

          Materials and methods

          Ten coronary arteries of eight fresh human hearts were used in this study. The anastomosis was performed with the implantation of a graft vessel into the lumen of the coronary artery by performing stent fixation. The technique is described and photo documented in detail. The durability and the conductibility of the anastomosis were examined with intraluminal endoscopy, functional streaming test, and a coloring of the vessels.

          Results

          The anastomosis had great results in all cases. Obstruction, dissection, or dislocation of the vessels was not observable.

          Conclusions

          This study confirmed the ex-vivo feasibility of the described technique. This method can be an easy, fast, and reliable method applied in the endoscopic distal coronary artery anastomosis surgery. The development of stents adapted to this method and the in-vivo testing of this technique are necessary for the future.

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          Most cited references19

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          Sutureless coronary artery bypass with biologic glued anastomoses: preliminary in vivo and in vitro results.

          As heart surgery becomes increasingly focused on minimally invasive techniques, it has become apparent that conventional techniques of anastomosis will need to be severely altered or abandoned. Toward that end, we developed and tested in vitro and in vivo coronary artery bypass graft anastomoses using a biologic glue formulated from bovine albumin and glutaraldehyde. We used a double-balloon catheter as a temporary internal stent to create and seal the anastomosis during gluing. Initially, anastomoses were made between cryopreserved human saphenous vein segments and coronary arteries in vitro on 12 intact bovine hearts. A total of 42 anastomoses were created with the catheter system introduced into the distal end of the graft, exiting the back wall, and entering the anterior wall of the coronary artery. Two balloons (one in the graft and one in the coronary artery) held the anastomosis stable while the biologic glue was applied externally and allowed to set for 2 minutes. The balloon catheter was then removed from the end of the graft simulating a side-to-side internal thoracic artery anastomosis. After the graft had been flushed to assure distal end patency, the open end of the graft was clipped, turning the anastomosis into an end-to-side graft. A pressure transducer was then attached to the graft and saline solution forcefully infused. All grafts easily held a pressure of 300 mm Hg; 10 grafts were tested up to 560 mm Hg without leaks. Distal and proximal coronary artery patency was checked by examining flow out of the coronary ostia and by cutting arteries distal to the grafts. All anastomoses were patent on being opened and no glue was seen intraluminally. Subsequently, 3 anastomoses of the left internal thoracic artery to the left anterior descending artery have been constructed in goats, with autopsies at 24 hours, 10 months, and 1 year revealing patent anastomoses. A biologic glue and catheter system has been developed that allows a coronary anastomosis with a high bursting strength to be performed. When the system has been further developed and tested, truly minimally invasive heart surgery may be possible.
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            Robotic Total Arterial Off-Pump Coronary Artery Bypass Grafting: Seven-Year Single-Center Experience and Long-Term Follow-Up of Graft Patency

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              Totally endoscopic coronary artery bypass surgery: A meta-analysis of the current evidence.

              Totally endoscopic coronary artery bypass (TECAB) has emerged as an alternative to other minimally invasive techniques. However, limited TECAB results are available to date. The purpose of this systematic review is to examine the existing literature to give an objective estimate of the outcomes of TECAB using a meta-analytical approach.
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                Author and article information

                Journal
                Interv Med Appl Sci
                Interv Med Appl Sci
                IMAS
                Interventional Medicine & Applied Science
                Akadémiai Kiadó (Budapest )
                2061-1617
                2061-5094
                07 October 2019
                September 2020
                September 2020
                : 11
                : 3
                : 187-192
                Affiliations
                [ 1 ]Laboratory for Applied and Clinical Anatomy, Department of Anatomy, Histology and Embryology, Semmelweis University , Budapest, Hungary
                [ 2 ]Department of Otorhinolaryngology, Head and Neck Surgery, Semmelweis University , Budapest, Hungary
                [ 3 ] Medicopus Nonprofit Ltd. , Kaposvár, Hungary
                [ 4 ]1st Department of Pathology and Experimental Cancer Research, Semmelweis University , Budapest, Hungary
                [ 5 ]Department of Cardiac Surgery, Central Military Hospital , Bucharest, Romania
                Author notes
                [* ]Corresponding author: Tamás Ruttkay; Laboratory for Applied and Clinical Anatomy, Department of Anatomy, Histology and Embryology, Semmelweis University, 26 Üllői St, H-1085 Budapest, Hungary; Phone: +36 1 4501500/53638; Fax: +36 1 2155158; E-mail: ruttkay.tamas@ 123456med.semmelweis-univ.hu
                Article
                10.1556/1646.11.2019.23
                9467338
                683a3eb3-92b1-43c3-8807-60a6135ba894
                © 2019 The Author(s)

                This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium for non-commercial purposes, provided the original author and source are credited, a link to the CC License is provided, and changes – if any – are indicated.

                History
                : 13 May 2019
                : 03 July 2019
                : 08 July 2019
                Page count
                Figures: 3, Tables: 1, Equations: 0, References: 19, Pages: 6
                Funding
                Funding sources: None.
                Categories
                Original Paper

                sutureless anastomotic,coronary stent,coronary surgery,minimally invasive,vessel-to-vessel

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