Arteriotomy closure by glued patch in the porcine carotid artery

• Published in: The Annals of thoracic surgery Vol. 70; no. 4; pp. 1384 - 1388
• Main Authors: Bastiaanse, Jacqueline, Borst, Cornelius, van der Helm, Yvonne J.M, Loo, Karine H.H, Gründeman, Paul F
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.10.2000; Elsevier Science
• Subjects: Anastomosis, Surgical; Animals; Biological and medical sciences; Blood Flow Velocity - physiology; Blood Vessel Prosthesis; Bucrylate; Carotid Arteries - pathology; Carotid Arteries - surgery; Coronary Artery Bypass; Medical sciences; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Swine; Thoracoscopy; Tissue Adhesives; Vascular Patency - physiology; Closure; Toxicity; Surgical glue; Exploration; Suturation; Pig; Pericardium; Pathology; Vertebrata; Mammalia; Surgery; Animal; Carotid; Arteriotomy; Artiodactyla; Technique; Butyl acrylate(cyano) polymer; Patch; Ungulata; Comparative study
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/S0003-4975(00)01845-2

Background. A thoracoscopic approach to coronary bypass grafting warrants renewed search for facilitated vascular anastomosis methods. We reassessed tissue adhesion, sealing properties, and histotoxicity of iso-butyl-cyanoacrylate, in a simplified anastomosis model. Methods. In 12 Dutch landrace pigs, five arteriotomies were made in each carotid artery. The arteriotomies were closed by conventional microvascular suturing or by pericardial patch (Peri-Strips) and iso-butyl-cyanoacrylate. The animals were sacrificed at 2 hours (n = 2), 2 days (n = 5), and 4 weeks (n = 5). The arteries were examined by flow measurement, angiography, and histologic analysis. Results. The time required to close arteriotomies by conventional suturing was 257 ± 43 seconds (mean ± SD) and by glued patch 51 ± 27 seconds ( p < 0.001). In all arteriotomies covered by glued patch, complete hemostasis was obtained. At 2 days and 4 weeks, with both methods the same histologic results were observed. At follow-up, all carotid arteries were patent without stenoses. Conclusions. Arteriotomy closure by glued patch was simple, fast, reliable, and without signs of histotoxicity. Adhesives deserve to be reconsidered as an alternative to suturing in closed chest beating-heart coronary surgery.