Temporary luminal arteriotomy seal: II

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Presentation transcript:

Temporary luminal arteriotomy seal: II Temporary luminal arteriotomy seal: II. coronary artery bypass grafting on the beating heart Robin H Heijmen, MD, Cornelius Borst, MD, PhD, Rob van Dalen, MSc, Cees W.J Verlaan, Chantal M Mouës, MD, Yvonne J.M van der Helm, Paul F Gründeman, MD, PhD The Annals of Thoracic Surgery Volume 66, Issue 2, Pages 471-476 (August 1998) DOI: 10.1016/S0003-4975(98)00449-4

Fig 1 Top (A), lateral (B), and frontal (C) view of the coronary temporary luminal arteriotomy seal. The temporary luminal arteriotomy seal is straight in the length direction and slightly curved in the width direction. The “shark fin” is used for insertion, positioning, and retrieval of the seal. The Annals of Thoracic Surgery 1998 66, 471-476DOI: (10.1016/S0003-4975(98)00449-4)

Fig 2 After insertion, the temporary luminal arteriotomy seal completely covered the arteriotomy and provided a bloodless operative field without obstructing coronary artery flow (A). During suturing, the flimsy seal gave way when a needle was inserted between the seal and the arterial wall, without producing a leak (B). The Annals of Thoracic Surgery 1998 66, 471-476DOI: (10.1016/S0003-4975(98)00449-4)

Fig 3 Percentage circumference of left anterior descending coronary artery not covered by endothelium. The schematic drawing shows the temporary luminal arteriotomy seal (TLAS) (light gray) inside the left anterior descending coronary artery (internal diameter, 2.5 mm). The arteriotomy (dark gray) measures 2.5 mm in width. Data are presented as mean ± standard deviation. (∗Estimated circumferential coverage (%) by TLAS. †Constriction of the artery caused by the vascular clip proximal to the anastomosis and excluded from analysis.) The Annals of Thoracic Surgery 1998 66, 471-476DOI: (10.1016/S0003-4975(98)00449-4)

Fig 4 Representative recording from a pig coronary artery during insertion of the temporary luminal arteriotomy seal. The intraluminal seal did not impede phasic and mean blood flow. The Annals of Thoracic Surgery 1998 66, 471-476DOI: (10.1016/S0003-4975(98)00449-4)

Fig 5 Representative angiogram at 28 days postoperatively, revealing a patent left internal mammary artery to left anterior descending coronary artery anastomosis. The Annals of Thoracic Surgery 1998 66, 471-476DOI: (10.1016/S0003-4975(98)00449-4)

Fig 6 Transverse cross-section of the suture line in the mid segment of the anastomosis, 7 days postoperatively. Note the endothelial-like cells covering intimal hyperplasia at the suture line (insert). (C = coronary artery; G = graft; L = lumen.) (Hematoxylin and eosin stain; bar = 100 μm.) The Annals of Thoracic Surgery 1998 66, 471-476DOI: (10.1016/S0003-4975(98)00449-4)

Fig 7 Transverse cross-section of the suture line in the midsegment of a temporary luminal arteriotomy seal anastomosis, 28 days postoperatively. (C = coronary artery; G = graft; IH = intimal hyperplasia; L = lumen.) (Elastin von Gieson stain; bar = 100 μm.) The Annals of Thoracic Surgery 1998 66, 471-476DOI: (10.1016/S0003-4975(98)00449-4)