Nonpenetrating stapling: a valuable alternative for coronary anastomoses?

Area of Science:

• Cardiovascular Surgery
• Vascular Anastomosis Techniques
• Minimally Invasive Cardiac Procedures

Background:

• Suture-based anastomoses pose challenges in minimally invasive coronary artery bypass grafting.
• Non-penetrating stapling presents a simpler alternative with potential for enhanced endothelial preservation.

Purpose of the Study:

• To compare the efficacy and safety of non-penetrating stapling versus conventional suturing for coronary artery bypass anastomoses.
• To evaluate endothelial function and graft patency in experimental and clinical settings.

Main Methods:

• Experimental: Porcine arterial rings (internal mammary artery to left anterior descending) were anastomosed using sutures or microclips. Endothelium-dependent relaxations to bradykinin were assessed.
• Clinical: Patients underwent coronary artery bypass grafting using either sutured left internal mammary artery or stapled saphenous vein grafts. Angiography assessed graft patency.

Main Results:

• Experimental: No significant difference in maximal relaxations between microclipped and sutured anastomoses, though both were lower than controls. Histology showed comparable endothelial preservation.
• Clinical: Stapled anastomoses showed no clip-related complications. Of 13 stapled saphenous vein grafts, 12 were patent with a "shark-mouth" configuration; one graft was occluded.

Conclusions:

• Non-penetrating stapling is an easy-to-use technique for coronary artery bypass grafting with promising immediate results.
• Further research is needed to establish the long-term role of non-penetrating stapling in minimally invasive cardiac surgery.