Key issues in sutureless vascular anastomoses
Since the beginning of cardiovascular surgery, anastomoses have been performed with hand-held sutures basically based on the principles of suture technique described by Alexis Carrel in 1902 . Even if in the last 100 years many other techniques have been proposed to join two vessels, the comfort to surgeons in performing a reliable anastomosis with the suture technique and the excellence of its long term results have led to its adoption as the gold standard. Therefore we should ask ourselves if we really need an alternative way to construct the vascular anastomosis. A key element to perform a safe and accurate hand-sutured coronary anastomosis is to have a bloodless operating field and an arrested heart. Surgical environment is becoming more and more challenging since off-pump CABGs and minimally invasive approach have been introduced. Surgeons have to deal with more and more diseased vessels since patient’s age and comorbidities continue to increase. Automated anastomotic technologies will enable the creation of rapid, precise and consistent anastomoses and this perfectly match the surgeon’s needs. We are looking for alternative ways to construct a coronary or any vascular bypass in order to reduce the technical demand, standardise the quality of the surgical procedure, reduce the individual surgical dexterity as a determinant factor for anastomosis outcome and possibly, expediting the procedure and reduce costs of the surgical treatment.
KeywordsLaser Welding Fibrin Glue Suture Technique Vascular Anastomosis Nitinol Wire
Unable to display preview. Download preview PDF.
- 2.Yoshimatsu N (1970) Study of strength of parts of human heart. J Kyoto Pref Med Univ (1958) 641:553. In: Yamada H, Evans FG (eds) Strength of biological materials. Williams & Wilkins, Baltimore, p 113Google Scholar
- 5.Androsov PI (1956) New method of surgical treatment of blood vessel lesions. Arch Surg 73:902Google Scholar
- 8.Dobrin PB, Littooy FN, Endean ED (1989) Mechanical factors predisposing to intimal hyperplasia and medial thickening in autogenous vein grafts. Surg 105(3):393–400Google Scholar
- 23.Berdat PA, Pfammatter JP, Pavlovic M, Carrel T (2003) A new clip device for construction of interrupted anastomosis in congenital cardiac surgery. The Heart Surgery Forum (submitted)Google Scholar
- 27.Stansby G, Knez P, Berwanger CS, Nelson K, Reichert V, Schmitz-Rixen T (2001) Does vascular stapling improve compliance of vascular anastomoses? J Vasc Surg 35:115–121Google Scholar
- 30.Gottlob R, Blumel G (1968) Anastomoses of small arteries and veins by means of bushings and adhesive. J Cardiovasc Surg 9:337–341Google Scholar