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Ann Thorac Surg 1999;68:1443-1444
© 1999 The Society of Thoracic Surgeons

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Correspondence

Favorable aspect of stapled anastomosis: an endothelial function study

^a Montreal Heart Institute, 5000 Belanger St, E, Montreal, PQ, Canada H1T 1C8
^b Department of Cardiovascular Surgery, Hôpital Lariboisière, 2, rue Ambroise Pare, 75475 Paris Cedex 10, France

e-mail: lpperrau{at}icm.umontreal.ca
e-mail: carchir{at}erb.ap-hop-paris.fr

To the Editor

We have read with great interest the article of Izzat and colleagues, and commend the authors for their documentation of an improved aspect of the endothelial surface of anastomotic sites with use of the stapled anastomosis [1]. We have reported, in The Annals of Thoracic Surgery [2], a study of physiological evaluation of the anastomotic site in a similar porcine model using internal mammary to left anterior descending artery anastomosis. It was demonstrated that the coronary ring on which the anastomosis was performed did have vascular reactivity, as evidenced by contraction to potassium chloride and prostaglandin F2, as well as endothelium-dependent relaxations to the agonist bradykinin. There were no significant differences in the concentration-responses curves between the anastomosis performed with the staples versus the conventional group using 8-0 Prolene sutures, as well as no differences in the histological aspect of the two groups of rings studied. We believe that stapled anastomosis may become advantageous, particularly in minimally invasive approaches, as they seem to be equivalent to standard techniques and could eventually facilitate construction of anastomosis and decrease operative time. We caution surgeons in believing that this technique may be superior to standard sutures anatomosis, because the incidence of anastomotic complications such as thrombosis due to infringement of polypropylene suture in the arterial lumen or early intimal hyperplasia is extremely low [3] in contemporary cardiac revascularization surgery. The failure of such sensitive techniques as endothelial function studies to demonstrate the superiority of the stapled anastomosis may have more power and relevance than morphological studies, even when obtained with electron microscopy. Of great concern in the study reported, as in our own, is the limitation of the models using normal coronary arteries, which do not perfectly reproduce the conditions of the clinical setting [4], because the majority of patients who come to coronary artery bypass surgery have a significant coronary endothelial dysfunction from advanced atherosclerosis. It is our belief, however, that the current industry and research efforts must be maintained to add new tools to the armamentarium of coronary artery bypass surgery, particularly in the ongoing trend of minimally invasive approaches and development of robotic systems.

References

1. Izzat M.B., Yim A.P.C., Ho K.C.H., Chan C.S.Y., Yew D., Chow L.T.C. Favorable scanning electron microscopic findings of stapled saphenous vein-carotid artery anastomoses. Ann Thorac Surg 1999;67:85-88.[Abstract/Free Full Text]
2. Lisi G., Perrault L.P., Menasché P., et al. Nonpenetrating stapling. Ann Thorac Surg 1998;66:1705-1708.[Abstract/Free Full Text]
3. Bryan A.J., Angelini G.D. The biology of saphenous vein graft occlusion. Curr Opin Cardiol 1994;9:641-649.[Medline]
4. Perrault L.P., Menasché P., Bidouard J.P., et al. The endothelium in minimally invasive surgery. Can J Cardiol 1997;13(Suppl):116C.

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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Louis P. Perrault Philippe Menasché Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Chavanon, O. Articles by Menasché, P. Search for Related Content PubMed PubMed Citation Articles by Chavanon, O. Articles by Menasché, P.