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Ann Thorac Surg 2007;84:1724-1727. doi:10.1016/j.athoracsur.2007.04.045
© 2007 The Society of Thoracic Surgeons
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Friedrich W. Mohr
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New Technology

Catheter-Based Endoscopic Bypass Grafting: An Experimental Feasibility Study

Stephan Jacobs, MDa,*, David Holzhey, MDa, Hubert Stein, BS, BMEb, Friedrich W. Mohr, MD, PhDa, Volkmar Falk, MD, PhDa

a Department of Cardiac Surgery, Heartcenter, University of Leipzig, Leipzig, Germany
b Department of Clinical Development Engineering, Intuitive Surgical, Sunnyvale, California

Accepted for publication April 13, 2007.

* Address correspondence to Dr Jacobs, Klinik für Herzchirurgie, Universität Leipzig, Herzzentrum, Strümpelstrasse 39, Leipzig, 04289, Germany (Email: stjacobs{at}aol.com).

Purpose: Construction of an endoscopic catheter-guided, bonded anastomosis to facilitate total endoscopic coronary artery bypass.

Description: Total endoscopic coronary artery bypass of the left internal thoracic artery to the left anterior descending coronary artery was performed on the beating heart in six pigs using a telemanipulation system. An angioplasty catheter was advanced through the left internal thoracic artery to stabilize the anastomotic site. The anastomosis was created by applying glue externally to the surrounding tissue of the left internal thoracic artery and the left anterior descending coronary artery while it was kept open by an inflated angioplasty catheter.

Evaluation: Angiography and catheter placement at the graft site was performed in 12 minutes (10 to 28 minutes). The anastomotic constructions were easily accomplished in 3.5 minutes (2 to 4.5 minutes). The adverse events that were encountered were anastomotic leakage requiring additional glue and left anterior descending artery dissection due to the guidewire. All except one animal with an open graft and anastomosis survived the procedure. Patency was 5 of 6.

Conclusions: Catheter-based endoscopic bypass grafting is feasible. The combination of robotic technology and this simple technique for anastomotic construction may facilitate beating heart total endoscopic coronary artery bypass.


Related Article

Invited commentary
Harald C. Ott
Ann. Thorac. Surg. 2007 84: 1727-1728. [Extract] [Full Text] [PDF]



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H. C. Ott
Invited commentary
Ann. Thorac. Surg., November 1, 2007; 84(5): 1727 - 1728.
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