Jules S. Scheltes, MSc, Carolien J. van Andel, MSc, Peter V

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Presentation transcript:

Coronary anastomotic devices: blood-exposed non-intimal surface and coronary wall stress Jules S. Scheltes, MSc, Carolien J. van Andel, MSc, Peter V. Pistecky, MSc, Cornelius Borst, MD, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 126, Issue 1, Pages 191-199 (July 2003) DOI: 10.1016/S0022-5223(03)00021-7

Figure 1 Cumulative number of patent applications on coronary end-to-side and side-to-side anastomoses published in the patent literature during the last 30 years. Data were obtained from the database of the European patent office (esp@cenet, http://nl.espacenet.com). The search was restricted to United States and European patent applications and applications published by the World Intellectual Property Organization. Because ideas can be patented in a series of patent applications (continuations, divisions, or parallel applications in the United States, Europe, and at the World Intellectual Property Organization), a distinction was made between the total number of patent applications and the number of patent applications that describe truly new ideas. The Journal of Thoracic and Cardiovascular Surgery 2003 126, 191-199DOI: (10.1016/S0022-5223(03)00021-7)

Figure 2 Sketches of longitudinal sections and cross-sections of anastomosis configurations for the distal end-to-side and side-to-side coronary anastomosis found in the patent literature, categorized according to the obtained wall apposition. For each configuration, the number of patents containing truly new ideas is noted, together with the range of the media-adventia area exposed to blood (tissue blood-exposed non-intimal surface [tissue-BENIS]). A patent may be categorized in more than 1 configuration, because the elaboration of some inventions shows the applicability on different anastomosis configurations. The Journal of Thoracic and Cardiovascular Surgery 2003 126, 191-199DOI: (10.1016/S0022-5223(03)00021-7)

Figure 3 Tissue- and foreign-BENIS area in sketches of longitudinal sections and cross-sections of anastomoses constructed using the conventional running suture technique (A), an intentionally constructed adventitia rim15 (B), along with recently introduced anastomotic bonding frames: the GraftConnector (C), the MVP rings (D), the St Jude Medical distal connector (E), and the Crinoline frame (F). To obtain realistic dimensions of the graft, coronary artery, and bonding components, the dimensions were taken from published studies (C, E, F) or patent applications18,19 (D). For each anastomosis, the area of the media-adventitia edge (tissue-BENIS) was estimated, as well as the area of foreign body material (foreign-BENIS) exposed to blood. The anastomotic devices are drawn to scale. The Journal of Thoracic and Cardiovascular Surgery 2003 126, 191-199DOI: (10.1016/S0022-5223(03)00021-7)

Figure 4 Finite element model (FEM) of bending the arteriotomy edge of differently shaped arteriotomies and boundary conditions: A, Longitudinal slit arteriotomy with no eversion of the arteriotomy edge and distributed loads along the cheek edge. B, Longitudinal slit arteriotomy with 90° arteriotomy edge eversion and distributed loads along the edge. C, Slit arteriotomy with 90° arteriotomy edge eversion and intermittent loads on the arteriotomy edge. D, Oval arteriotomy with 90° arteriotomy edge eversion and distributed loads along the edge. (The material model and boundary conditions used for the FEM are explained in Appendix III.) The Journal of Thoracic and Cardiovascular Surgery 2003 126, 191-199DOI: (10.1016/S0022-5223(03)00021-7)