Biomedical subjects

Gerhard Wimmer-Greinecker

Publications and source records attributed to Gerhard Wimmer-Greinecker.

At least 19 recordsLinked to original sources

PubMed2005

Degradation of microvascular brain endothelial cell beta-catenin after co-culture with activated neutrophils from patients undergoing cardiac surgery with prolonged cardiopulmonary bypass.

The adhesion of highly activated neutrophils to cerebral microvascular endothelial cells (MVECs) may contribute to disruption and hyperpermeability of the blood-brain barrier (BBB) after cardiac surgery with prolonged cardiopulmonary bypass (CPB). A correlation between CPB duration and neutrophil-mediated BBB damage has not been investigated on the cellular level yet. Therefore, we studied the effects of neutrophils from cardiac surgery patients with CPB time <80 min (group I; n=8) and >80 min (group II; n=8) on the integrity of cultured porcine MVEC. Ex vivo, neutrophils of group II but not of group I significantly degraded the zonula adherens molecule beta-catenin whereas VE-cadherin and occludin were not modified. The transendothelial electric resistance as a measure for the integrity of the endothelial monolayers was reduced over time in both groups. In conclusion, prolonged CPB time entails neutrophil-mediated decrease in MVEC beta-catenin expression, and thus may be an important trigger for BBB disruption.

Animals↗

PubMed2005

Aortic leaflet replacement with the new 3F stentless aortic bioprosthesis.

PURPOSE: Clinical trials with the new 3F stentless aortic bioprosthesis began October 2001, and as one of the first centers to implant this prosthesis in humans, we would like to present our experiences with this new device. DESCRIPTION: The 3F aortic bioprosthesis is a stentless biological heart valve fabricated from three equal leaflets of equine pericardium, assembled in a tubular shape, and implanted in the native aortic root to replace the patient's diseased aortic leaflets. Between January 2002 and August 2002, 24 3F aortic bioprostheses were implanted at our institution. Effective orifice area, mean gradients, and ejection fraction were evaluated by echocardiography at discharge and at 12-month follow-ups after surgery. EVALUATION: At 12-month follow-ups, the 3F bioprosthesis showed a good hemodynamic performance with a significant drop of mean gradients to 10.3 mm Hg, a mean effective orifice area of 1.7 cm2, and a mean ejection fraction of 61.5%. CONCLUSIONS: The clinical performance of the new 3F aortic bioprosthesis is comparable with regular stentless aortic valves. However its unique design facilitates implantation.

Adult↗

PubMed2005

Minimally invasive port access versus conventional mitral valve surgery: prospective randomized study.

BACKGROUND: We compared the port access mitral valve surgery with the conventional procedure through median sternotomy in a prospective randomized study. METHODS: Forty elective patients with mitral valve disease were prospectively randomized to undergo minimally invasive (group I) or conventional (group II) mitral valve operation. The patients of group I had limited access through right small anterior thoracotomy and a femorofemoral cardiopulmonary bypass system using the endoclamp technique. To assess the efficiency and safety of the procedure, intraoperative and postoperative clinical data and markers of myocardial, cerebral, and lower limb ischemia were collected. Pulmonary function tests were performed to compare the preservation of pulmonary function. Neuropsychological tests were conducted for quantification of neurological and cognitive disorders. RESULTS: Mitral valve reconstructions were performed in 28 patients (70%) in both groups. Intraoperative procedure-associated problems were experienced in 9 patients (45%) in group I, and 6 of them (30%) had to be converted to direct transthoracic aortic clamping. Markers of myocardial and cerebral damage as well as pulmonary and neuropsychological tests did not show statistically significant difference between groups. CONCLUSIONS: The minimally invasive port access technique for mitral valve surgery can be done with similar clinical safety as procedures through median sternotomy. The problems with endoclamping have forced us to change our practice to the more simple and economic transthoracic aortic clamping technique.

Cardiopulmonary Bypass↗

PubMed2005

Initial experience with a minimized extracorporeal bypass system: is there a clinical benefit?

BACKGROUND: Drawbacks of conventional cardiopulmonary bypass (CPB) are increased inflammatory response, deteriorated coagulation and systemic organ dysfunction. A closed extracorporeal circuit (CorX) features reduced foreign surface area and priming volume. Potential benefits were studied in comparing the CorX system with conventional CPB in arrested heart coronary artery bypass grafting (CABG). METHODS: Two hundred and four patients were randomly assigned either to CorX system (n = 101, group A) or a standard CPB with cardiotomy reservoir (n = 103, group B). Besides evaluation of perioperative data and routine blood samples, we focused on lung function and perioperative bleeding. Polymorphonuclear elastase (PMNE) and terminal complement complex (TCC) served to assess inflammatory response. RESULTS: Patient demographics and operative data did not differ between groups. Postoperative lung function was not significantly impaired comparing groups A and B. Intraoperative blood loss was significantly higher in group A compared with group B (1245 +/- 947 mL vs 313 +/- 282 mL, p < 0.0001) as well as the need of fresh frozen plasma. Postoperative chest drainage did not differ significantly between groups. Two patients in each group required re-exploration due to bleeding. One hour after CPB, PMNE as well as TCC were significantly lower in group A compared with group B (PMNE: 76 +/- 44 ng/mL vs 438 +/- 230 ng/mL, p < 0.0001; TCC: 16 +/- 8 IU/mL vs 29 +/- 19 IU/mL, p < 0.0001). CONCLUSIONS: The CorX system is safe and feasible in patients undergoing CABG. Despite of markedly reduced inflammatory reaction, no clinical benefit was observed.

Aged↗

PubMed2005

Decreased intermediate term patency of automated proximal anastomoses evaluated by sequential ultrafast CT.

OBJECTIVE: The Symmetrytrade mark aortic connector creates proximal anastomoses of saphenous vein grafts using a nitinol implant. The device avoids partial clamping and thus possibly reduces neurologic complications. To evaluate graft patency, a single surgeon randomised study was performed in our institution. METHODS: Seventy-seven patients were randomised either to automated proximal anastomoses (group I, n=39, 61 vein grafts connected using the aortic connector, 47 as single, 15 as sequential bypasses) or controls (group II, n=38, 62 proximal anastomoses handsewn, 46 as single, 16 as sequential bypasses). Ultrafast CT-scans were performed on postoperative day 5 in 34 patients of group I and 16 patients of group II to evaluate early graft patency. Intermediate term patency was evaluated with ultrafast CT-scan in 30 patients of group I (46 grafts) and 25 patients of group II (39 grafts) 1 year after the operation. RESULTS: Two early graft occlusions were detected in group I (3.8%). In group II all evaluated grafts were patent 5 days after surgery. 11.4 months after surgery, seven out of 46 grafts were found occluded (15.2%) in group I. In the control group, only one occlusion was detected (2.6%). CONCLUSIONS: We observed a trend towards an increased occlusion rate 1 year after surgery with automated connector devices. For evaluation of long-term patency larger patient groups have to be evaluated. Other benefits of these devices have to be proven to promote their clinical application.

Adult↗

PubMed2005

Valve opening and closing dynamics after different aortic valve-sparing operations.

BACKGROUND AND AIM OF THE STUDY: Aortic valve resuspension for ascending aortic aneurysm repair is associated with removal of the sinus of Valsalva. This may cause changes in leaflet motion and thus impact on long-term durability. The opening and closing characteristics of the aortic valve leaflets after reimplantation were studied using a published technique and a modification to create a 'neosinus', and the results compared to those of an age-matched control group. METHODS: Between September 1995 and March 2002, 25 patients underwent normal aortic root reconstruction (group A), while in a further 21 patients the modified neosinus technique was used (group B). In both groups, the native valve was preserved and suspended inside a tubular prosthesis, with reimplantation of the coronary arteries. Transthoracic and transesophageal studies of aortic valve dynamics were performed intraoperatively, before hospital discharge, and at one year after surgery in all patients; the data were compared with those from a separate group of 25 matched control individuals (group C). RESULTS: The valve opening velocity was 61.3+/-20.1, 46.3+/-8 and 29.2+/-9.8 cm/s in groups A, B and C, respectively (group A versus B, p = 0.003; A versus C, p <0.0001; B versus C, p <0.0001). Closing velocity was increased to 57.5+/-23 and 43.8+/-7 cm/s in groups A and B, compared to 23.6+/-7 cm/s in group C (A versus B, p = 0.012; A versus C, p <0.0001; B versus C, p = 0.0002). In seven group A patients, the leaflets touched the prosthetic wall during systole. Slow systolic closing displacement (SCD) amounted to 7.3+/-6 % of maximal opening in group A and 12.6+/-5 % in group B (p = 0.05), compared to 21.1+/-8.3% in group C (group A versus group C, p <0.0001; B versus C, p = 0.002). CONCLUSION: Reimplantation of the natural aortic valve in a prosthetic graft causes abnormally high opening and closing speeds, with possibly increased stress. The study results showed lower valve opening and closure dynamics after the creation of a sinus bulge compared to the conventional reimplantation technique. However, mid-term clinical observations showed favorable valve competence for both types of repair. Further long-term follow up is necessary to prove whether more physiological leaflet dynamics lead to improved durability.

Adolescent↗

PubMed2004

Current status of robotically assisted coronary revascularization.

This article reviews the current status of totally endoscopic coronary revascularization using telemanipulation systems for robotic assistance. Current challenges in implementing a robotic surgical program are discussed, and application of the technology in both arrested and beating heart procedures is considered.

Cardiac Surgical Procedures↗

PubMed2004

Successful treatment of deep sternal infections following open heart surgery by bilateral pectoralis major flaps.

OBJECTIVES: Severe sternum necrosis requiring extended resection necessitates plastic reconstruction of the resulting defect and stabilization of the chest. We analyzed the outcome of patients undergoing bilateral pectoralis major flap repair on functional and cosmetic results, chest stabilization and pulmonary function. METHODS: Twelve patients undergoing cardiac surgery between 1997 and 2001 suffered from a deep mediastinal wound infection and sternum necrosis. After a mean of two attempts of extensive wound debridement, all 12 patients underwent complete sternal resection with plastic reconstruction by bilateral pectoralis major flaps. Risk factors were obesity (n=10) and diabetes (n=11). Six months postoperatively patients underwent physical examination, pulmonary function testing and functional CT scan. RESULTS: Three patients died in hospital (two septic multiorgan failure, one heart failure) and nine were discharged with complete wound closure. One patient suffered a lethal stroke during follow-up. At 6-month follow-up no recurrent sternum infection had occurred. Chest stability was satisfactory without impairment of pulmonary function (VC 77.5+/-12.1% at follow-up vs 77.8+/-12.5% preoperatively). Mobility and force of arms and shoulder were adequate; at CT scan the maximum distance change between the former sternoclavicular joint in inspiration versus expiration was minimal. Quality of life questionnaires showed no significant limitations except a disturbed sleep and mild restriction of executing hobbies and social activities. CONCLUSIONS: Bilateral pectoralis major flap repair is a safe technique to cure severe mediastinitis necessitating complete sternal resection. Wounds close without extensive reconstructive surgery. Cosmetic results as well as stabilization of the chest were good. Patients reported an almost uncompromised quality of life without respiratory impairment.

Aged↗

PubMed2004

Automatic connector devices for proximal anastomoses do not decrease embolic debris compared with conventional anastomoses in CABG.

OBJECTIVE: Emboli generated during cardiac surgery have been associated with aortic clamping and manipulation. Proximal anastomotic devices are thought to be less traumatic by eliminating partial clamping, potentially resulting in fewer adverse outcomes. Intra-aortic filtration has been shown to effectively capture particulate debris. We compared the amount of debris released using intra-aortic filtration and the clinical outcomes between conventionally handsewn and automated proximal anastomoses. METHODS: Seventy-seven patients undergoing primary coronary artery bypass grafting with cardiopulmonary bypass were enrolled in a prospective randomized study. Patients were assigned to the anastomotic device Group I (Symmetry Aortic Connector, n = 39) or the conventional handsewn anastomosis control Group II (n = 38). Proximal anastomoses were performed before cardiopulmonary bypass in both groups. Intra-aortic Filter 1 (EMBOL-X)was deployed prior to partial clamping or puncturing the aorta for device application and removed after the proximal anastomosis was completed. Prior to cross-clamp removal, a second filter was inserted (Filter 2). A core laboratory performed quantitative and histologic analyses of the debris captured. Clinical outcomes included adverse events, neurocognitive test scores, graft patency, and mortality. RESULTS: Preoperative variables and risk factors were not significantly different between Groups I and II (EuroSCORE 3.9+/-2.6 vs. 4.2+/-2.5). Filter analyses showed no significant difference between Groups I and II in Filter 1 or 2 for either surface area of particles or total number of particles (P> 0.005). There was a significant decrease between Filters 1 and 2 in both Groups for surface area of particles (Group I: 18.5+/-23.8 mm2 vs. 10.7+/-16.3 mm2, P = 0.017; Group II: 15.0+/-15.4 mm2 vs. 6.9+/-.6.5 mm2, P = 0.004), and for total number of particles in Group II (8.6+/-3.7 vs. 7.1+/-2.4, P = 0.023). No significant differences were observed between Group I (device) and Group II (control) outcomes for myocardial infarction, neurocognitive deficit, stroke, length of stay, graft occlusion, or mortality. CONCLUSIONS: The application of proximal aortic connectors without partial clamping does not reduce particulate emboli or affect clinical outcomes compared with conventional anastomoses. Cross-clamping during cardiopulmonary bypass produces less particulate debris than conventional or automated proximal anastomoses performed off-pump, suggesting a major source of emboli is the anastomotic process.

Adult↗

PubMed2004

In vivo inhibition of neutrophil activity by a FAS (CD95) stimulating module: arterial in-line application in a porcine cardiac surgery model.

OBJECTIVE: Cardiac surgery with cardiopulmonary bypass is associated with aberrant neutrophil activation and potentially severe pathogenic sequelae. This experimental study was done to evaluate a leukocyte inhibition module that rapidly inactivates neutrophils through CD95 stimulation. METHODS: German landrace pigs (4 groups, each n = 5) underwent cardiac surgery without cardiopulmonary bypass (group I), with cardiopulmonary bypass (group II), with cardiopulmonary bypass plus a leukocyte filter (group III), and with cardiopulmonary bypass plus a leukocyte inhibition module (group IV). The leukocyte filter or leukocyte inhibition module was introduced into the arterial line of the heart-lung machine. RESULTS: Leukocyte counts were decreased by up to 43% in group IV compared with values in group II (P =.023). In group IV, but not in groups I to III, no delay in spontaneous neutrophil apoptosis was observed after annexin V-propidium iodide staining. Late apoptotic (11.7%) or necrotic neutrophils (9.3%) were detected in 2 animals (group IV). Tumor necrosis factor alpha serum levels increased over time in groups I to III (>2-fold) but remained at baseline levels in group IV (P <.05). Interleukin 8-mediated chemotactic neutrophil transmigration activity increased over time in groups I to III but was totally abrogated in group IV at any time point. The perioperative increase of creatine kinase and creatine kinase MB levels was lower in groups III (1.5-fold and 1.3-fold, respectively) and IV (1.2-fold and 1.5-fold, respectively) compared with values in group II (both 1.9-fold). CONCLUSIONS: The leukocyte inhibition module downregulated cardiopulmonary bypass-related neutrophil activity and thus might be beneficial in cardiac surgery and other clinical settings with unappreciated neutrophil activation.

Animals↗

PubMed2004

Progress in CT imaging for the cardiac surgeon.

The aim of this article is to critically assess the role of multidetector-row CT (MDCT) in the field of cardiothoracic surgery. In the beginning, a short overview is given about technical aspects such as scan protocols, optimal image reconstruction, image reformation techniques, data evaluation, and data presentation. This is followed by sections about possible indications for cardiothoracic surgery and future prospects for this technology. For the cardiac surgeon, the main benefit of MDCT lies in the combination of large scan-volume coverage, high spatial resolution, proper identification of calcifications, and the simultaneous registration of other thoracic structures. Preoperative applications may include the assessment of cardiac valves, noninvasive evaluation of large thoracic vessels, staging of cardiac tumors, and planning of minimally invasive surgical procedures. After surgery, MDCT examinations particularly facilitate an early identification of severe postoperative complications. MDCT may also be used to assess coronary artery bypass graft patency and to identify transplant-related complications in heart transplant recipients at an early stage. New technological developments such as 64-row MDCT or flat panel computed tomography will further increase the field of possible indications.

Coronary Artery Bypass↗

PubMed2004

The Na+/H+ exchange inhibitor HOE642 prevents stress-induced epithelial barrier dysfunction.

Recently, evidence has been obtained that the Na+/H+ exchange (NHE) inhibitor HOE642 may stabilize endothelial and epithelial barrier function in vivo. However, the underlying mechanisms are not known. Therefore, we studied the influence of HOE642 on the barrier function of the epithelial cell line CaCo2. The phorbolester phorbol 12-myristate 13-acetate (PMA) was used to induce hyperpermeability of the epithelial layer which was indirectly determined by measuring the transepithelial electrical resistance (TER). Confocal laser scan microscopy (LSM) served to analyze the intracellular localization of adherens and tight junction molecules. In five independent experiments we found that HOE642 increased TER in non-treated CaCo2 cells (control: 350 +/- 28 Omega/cm2; HOE642: 444 +/- 53 Omega/cm2) and prevented PMA-induced barrier dysfunction (PMA: 33 +/- 12 Omega/cm2; PMA plus HOE642: 496 +/- 47 Omega/cm2). LSM showed that HOE642 prevented the PMA-induced disassociation of the zonula adherens molecule beta-catenin from the cell membrane and the decreased expression of the zonula occludens molecule ZO-1. From our data we conclude that HOE642 may prevent stress-induced epithelial dysfunction by stabilization of cell membrane-associated junction molecules.

Anti-Arrhythmia Agents↗

PubMed2003

Multidetector-row CT: cardiosurgery indications.

This article critically evaluates the role of multidetector-row CT before and after cardiosurgical procedures. In addition, technical aspects, such as scan protocols, optimal image reconstruction intervals, image reformation techniques, and data evaluation, are presented and briefly discussed.

Aortic Valve↗

PubMed2003

Awake coronary artery bypass grafting: utopia or reality?

BACKGROUND: Off-pump coronary artery bypass grafting (OPCAB) was implemented to reduce trauma during surgical coronary revascularization. High thoracic epidural anesthesia further reduced intraoperative stress and postoperative pain. This technique also supports awake coronary artery bypass (ACAB), completely avoiding the drawbacks of mechanical ventilation and general anesthesia in high-risk patients. We compared our first results of the ACAB procedure with the conventional OPCAB operation. METHODS: Thirty-five patients underwent ACAB (group A) with left internal mammary artery to left anterior descending coronary artery grafting using a partial lower ministernotomy (n = 25) or double bypass grafting (n = 9) and even triple vessel coronary artery revascularization (n = 1) through complete median sternotomy. Thirty-four patients (group B), matched for age, sex, and comorbidity with group A, underwent either partial lower ministernotomy (n = 24) or OPCAB by complete sternotomy (n = 10). We recorded clinical outcomes and postoperative visual analog scale pain scores. RESULTS: In group A, 32 patients remained awake throughout the entire procedure. Three patients required secondary intubation because of incomplete analgesia (n = 1) or pneumothorax (n = 2). Patients in group A had a recovery room stay of 6.0 +/- 3.2 hours. In group B, mechanical ventilation was implemented for 4.8 +/- 3.1 hours and intensive care unit stay lasted 12 +/- 6.8 hours. Group A had no in-hospital deaths, compared with 1 death in the conventional OPCAB group. Each group had 1 patient with graft stenosis detected on the predischarge angiogram. Early postoperative pain was significantly less in group A than in group B (visual analog scale of 32 +/- 8 compared with 58 +/- 11, p < 0.0001). CONCLUSIONS: The present data demonstrate the feasibility and safety of surgical coronary revascularization without general anesthesia. Continuation of thoracic epidural analgesia provides better pain control and faster mobilization after such procedures. Surprisingly, the ACAB procedure was well accepted by the patients.

Anesthesia, Epidural↗

PubMed2003

Emergent endovascular stent grafting for perforated acute type B dissections and ruptured thoracic aortic aneurysms.

BACKGROUND: The purpose of our study was to demonstrate the effectiveness of endovascular stent grafts in the treatment of acutely ruptured thoracic aortic aneurysms and type B dissections as an alternative to the conventional surgical approach in an emergency setting. METHODS: From January 2001 to October 2001, we deployed 11 emergent endovascular stent grafts into the thoracic aorta. We treated seven ruptured aortic aneurysms and four acutely perforated type B dissections. Aortic rupture was confirmed preoperatively by spiral computed tomography. In all cases, hemothorax was present. The average interval from onset of symptoms to treatment was 28.5 hours. We used nine Talent and two Excluder stent grafts. RESULTS: Deployment of the stent grafts was successful in nine cases. There were two cases of access failure due to small caliber of iliac arteries, and 1 of these patients died shortly after the procedure was abandoned, At 12 months of follow-up, there were no cases of paraplegia, stent migration, or endoleaks. There was, however, one temporary renal failure, and 2 patients required mechanical ventilation for more than 48 hours. CONCLUSIONS: Our experiences with emergency endovascular stent grafting show that the procedure is technically feasible, with less morbidity and mortality than conventional open surgery, in high-risk patients.

Adult↗

PubMed2003

Surgical versus endovascular treatment of acute thoracic aortic rupture: a single-center experience.

BACKGROUND: Surgical management of acute thoracic aortic ruptures is controversial, especially in patients with preexisting comorbidities; associated mortality and paraplegia rates remain high. It was our objective to evaluate whether treating these patients acutely with endovascular stent grafts would improve their outcome. METHODS: From November 1999 to February 2002 a total of 54 patients, age 28 to 83 years, were admitted to our institution with an acute rupture of the thoracic aorta (24 ruptured aneurysms, 14 perforated type B dissections, 16 traumatic ruptures). Twenty-eight patients were managed surgically using cardiopulmonary bypass (group 1), and 26 patients were treated acutely with an endovascular stent graft (group 2). The resuscitation protocol and interval from onset of symptoms to treatment was comparable in both groups. Medical records were reviewed for prehospitalization and emergency department data, operative findings, and outcomes. RESULTS: There were 5 of 28 deaths (17.8%) in the surgical group and 1 of 26 deaths (3.8%) in the endovascular group. In the surgical group 1 of 28 patients (3.6%) exhibited paraplegia; there were no cases of paraplegia in the endovascular group. There were 4 of 28 cases (14.3%) of renal failure in group 1 and 1 of 26 (3.8%) in group 2. In group 1, 8 patients (28.6%) required mechanical ventilation for more than 48 hours; there were 2 of 26 patients (7.7%) in group 2 with this ventilatory requirement. Three patients required a repeat thoracotomy for hemorrhage in the surgical group. There were two access failures in the endovascular group. CONCLUSIONS: In the treatment of acute ruptures of the thoracic aorta, the immediate outcome of patients treated with endovascular stent grafts appears to be better than with management by conventional surgical repair.

Adult↗

PubMed2003

Totally endoscopic atrial septal repair in adults with computer-enhanced telemanipulation.

OBJECTIVE: Standard surgical closure of an atrial septal defect via sternotomy is a safe and effective procedure with low morbidity and mortality. Considering that young female patients are frequently operated on for atrial septal defects, a minimally invasive procedure avoiding sternotomy is convincingly desirable and led to the approach through a right anterolateral minithoracotomy. The recent clinical introduction of robotically assisted surgery further reduced skin incisions and enabled totally endoscopic procedures through ports. This article reports on a first series of atrial septal defect closures of which the first case was operated on August 24, 1999, in a totally endoscopic closed chest technique using a computer-enhanced telemanipulation system. METHODS: We performed totally endoscopic atrial septal repair using the da Vinci surgical system (Intuitive Surgical, Mountain View, Calif) in 10 consecutive adult patients. Median age was 45.5 +/- 10.0 years, and preoperative New York Heart Association functional class was 1.8 +/- 0.1. Left ventricular ejection fraction was normal in all patients and mean pulmonary artery pressure amounted to 35 +/- 7 mm Hg. Shunt volume ranged from 24% to 70%. All patients displayed a fossa ovalis type of atrial septal defect; 2 of them multiperforated. RESULTS: Neither intraoperative nor postoperative complications occurred. Two patients had to be converted to minithoracotomy due to endoaortic balloon clamp failure. Length of operation was 262 +/- 37 minutes, and cardiopulmonary bypass time was 161 +/- 26 minutes. Intraoperative transesophageal echocardiography certified complete closure of the atrial septal defect in all patients. The totally endoscopic computer-enhanced technique yielded excellent cosmetic results. CONCLUSION: Totally endoscopic atrial septal repair is a feasible and safe procedure with good clinical results and excellent cosmetic outcomes. It may be considered as perfect adjunct to interventional treatment options. Further studies with larger cohorts and randomized trials are necessary to document potential benefits. Evolution in robotic technology and refinement of procedural flow may shorten procedural time and decrease costs.

Adult↗

PubMed2003

Facilitated endoscopic beating heart coronary artery bypass grafting using a magnetic coupling device.

BACKGROUND: Suturing of a coronary anastomosis in totally endoscopic coronary artery bypass grafting on the beating heart is technically demanding. The potential benefits of the endoscopic Magnetic Vascular Positioner device (Ventrica, Inc, Fremont, Calif) to facilitate construction of a coronary anastomosis in a closed chest environment were evaluated. METHODS: Totally endoscopic coronary artery bypass grafting on the beating heart was performed in 8 foxhound-beagle inbred dogs with the da Vinci telemanipulation system (Intuitive Surgical, Mountain View, Calif). A prototype of the endoscopic Magnetic Vascular Positioner device was used to facilitate construction of the coronary anastomosis. One pair of magnets was inserted in the internal thoracic artery and left anterior descending artery using robotic instruments to guide and place the endoscopic delivery platform. All animals underwent angiography; gross inspection of the anastomotic site was performed after excision of the hearts. RESULTS: The procedure was accomplished in all animals in 169 minutes (155-190 minutes). Dissection of the left anterior descending coronary artery (6.5 minutes; 1-20 minutes), positioning of the stabilizer (8.5 minutes; 7-16 minutes), placement of occlusion tapes (6 minutes, 3-10 minutes), and arteriotomy 5.5 minutes (3-30 minutes) was achieved without problems. By use of the Magnetic Vascular Positioner device, the anastomosis at the graft site was performed with the graft still in situ. Except for 1 premature deployment, all other deployments were easily accomplished in 3 minutes (1-28 minutes). The following adverse events were encountered: bleeding from the right ventricle caused by occlusion tape (1), anastomotic leakage on reperfusion requiring repair stitches (2), and anastomotic occlusion as a result of thrombus (1). All except 1 animal with a patent graft and anastomosis survived the procedure. The overall patency was 7 of 8. DISCUSSION: The combination of robotic technology allowing for dexterous manipulation in a closed chest environment and a simple yet effective and timesaving technique for anastomotic coupling may facilitate beating heart totally endoscopic coronary artery bypass grafting.

Anastomosis, Surgical↗