New Sutureless Technique Expedites Coronary Anastomoses in CABG Model

In a canine model of coronary artery bypass graft surgery (CABG), a new sutureless technique produces uniform side-to-side coronary anastomoses faster than standard suture methods and with comparable results, according study findings presented January 29 at the 37th annual meeting of The Society of Thoracic Surgeons.

The sutureless technique employs a novel stainless steel connector designed by the St. Jude Medical Cardiovascular Group, in St. Paul, Minnesota.

Dr. Hartzell V. Schaff, from the Mayo Clinic, in Rochester, Minnesota, and colleagues used the connector technique and the standard suture method to anastomose saphenous vein grafts to the left anterior descending (LAD) and left circumflex (LCX) arteries of 12 dogs. The connector was used in seven LAD and five LCX anastomoses and standard suture was used in five LAD and seven LCX anastomoses.

On average, connector anastomoses took 3 minutes, significantly faster than the 8.4 minutes achieved with sutured anastomoses. However, on average, an additional 8.5 minutes was required to load the connector, the researchers point out.

During the procedure, no mechanical failures were noted, and all connectors produced immediate hemostasis. At 30 days postprocedure, histology and angiographic results of the two anastomotic methods were comparable.

“This is a different kind of anastomotic device, different from any of the methods ÄusedÅ in the past for sutureless coronary anastomoses,” Dr. Schaff told Reuters Health.

“The device has been through several iterations and is now in a form that is probably usable clinically.” He noted that “the device has been used on people in Europe, but it is currently not approved by the FDA.”

Dr. Schaff pointed out that “while the connector method does make a difference in anastomotic time, that wouldn’t be the major reason to use it.” He explained that the “reproducibility of an anastomosis is probably just as important as the time.” However, “time saving is an issue, especially with off-pump surgery, and it may have a special application in this setting.”

“The time required to load the connector is the kind of thing that needs to be developed further, although the form that they have now is really pretty good,” Dr. Schaff added.