A Laser-Assisted Anastomotic Technique: Feasibility on Human Diseased Coronary Arteries

Background The excimer laser-assisted non-occlusive anastomosis (ELANA) bypass technique may have the advantage of its non-occlusive design in the treatment of last-resort cases where endovascular treatment or direct clipping is considered to be unsafe. However, the technique remains technically challenging. Therefore, a sutureless ELANA Clip device (SEcl) was developed to simplify the technique avoiding tedious anastomosis stitching in depth. The present study investigates the clinical feasibility and safety of the SEcl technique. Methods Three patients with complex and large aneurysms in the anterior circulation were selected after multidisciplinary consensus that the aneurysms were too complex for endovascular or direct clipping treatment options. Bypass surgery was considered as a last-resort treatment option, and after preoperative evaluation and informed consent, SEcl bypass surgery was performed. Applicability, technical aspects and patient outcomes are assessed. Results All aneurysms were excluded from the circulation. The creation of the intracranial anastomosis was easier and faster. No device-related serious adverse events were encountered, and all outcomes were favorable (one patient stable Modified Rankin Scale, two patients improved). Conclusion The SEcl anastomosis technique is feasible and, considering the severity of the disease, relatively safe. It can be considered a treatment option in very difficult-to treat last-resort aneurysm cases. From this study, further developments in minimizing clip size and application in cardiac surgery are initiated.

show abstract

What will surgical coronary revascularization look like in 25 years?

Caliskan

Falk

2019

Current Opinion in Cardiology

View full text Add to dashboard Cite

PURPOSE OF REVIEW Coronary artery bypass grafting evolved in incremental but significant steps since its introduction. Here, we provide an update on operative techniques, choice of conduits, patient selection/decision-making and primary and secondary prevention measures with potential of influencing the future of coronary artery bypass grafting (CABG) surgery. RECENT FINDINGS Associated mortality of off-pump CABG (OPCAB) procedures performed in high-volume OPCAB centers (164 cases per year) and by experienced surgeons (48 cases per year) was reduced compared with on-pump CABG with two or more grafts suggesting a volume-based dependency of outcomes in CABG procedures with high-technical complexity. Ten-year results from the recent Arterial Revascularization Trial showed no significant between-group difference for the primary and secondary outcome. Total arterial revascularization using composite bilateral internal mammary artery-Y-conduits through a limited access mini-thoracotomy was not only shown to be feasible but a safe and reproducible procedure with excellent midterm outcomes. The most recent Randomized Trial of Endoscopic or Open Vein-Graft Harvesting for Coronary-Artery Bypass (REGROUP) trial demonstrated no significant difference between open veingraft harvesting and endoscopic vein-graft harvesting in the occurrence of major adverse cardiac events. SUMMARY Adherence to the most recent guidelines on myocardial revascularization is a key component for providing state-of the CABG surgery. Trends to lesser invasiveness in surgical coronary revascularization will gain momentum and is expected-with further improvements-to be the mainstay of future surgical coronary revascularization strategies.

show abstract

A Laser-Assisted Anastomotic Technique: Feasibility on Human Diseased Coronary Arteries

Cited by 3 publications

References 20 publications

Anastomotic Devices for Coronary Artery Surgery

Anastomotic Devices for Coronary Artery Surgery

The Sutureless Excimer Laser Anastomosis Clip Pilot Study: a feasibility and safety study

What will surgical coronary revascularization look like in 25 years?

Contact Info

Product

Resources

About