Evaluation of a Novel Laser-assisted Coronary Anastomotic Connector - the Trinity Clip - in a Porcine Off-pump Bypass Model

Stecher, David; Bronkers, Glenn; Noest, Jappe O.T.; Tulleken, Cornelis A.F.; Hoefer, Imo E.; Herwerden, Lex A. van; Pasterkamp, Gérard; Buijsrogge, Marc P.

doi:10.3791/52127

Cited by 6 publications

(18 citation statements)

References 30 publications

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“…In addition, in absence of dedicated instruments, the construction took longer (T20 minutes) compared to the construction time (3.5 minutes) found in a porcine off-pump bypass model. 1 Hence, to succeed in minimally invasive anastomosis construction, dedicated application tools (ie, flexible laser and versatile applicator) and optimization of visualization by videoscopic assistance, are essential.…”

Section: Discussionmentioning

confidence: 99%

Total Arterial Minimally Invasive Direct Coronary Artery Bypass Surgery Facilitated by the Trinity Clip Connector

Stecher

Bronkers²,

Hoefer

et al. 2015

Innovations�(Phila)

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Objective This pilot study evaluated the feasibility of total arterial minimally invasive direct coronary artery bypass surgery by using the Trinity Clip anastomotic connector in an acute porcine model. Methods In 3 pigs, the left and right internal thoracic arteries (LITA and RITA) were harvested conventionally and the chest closed subsequently. After a left lateral thoracotomy, the coronary target was positioned and stabilized by an endo-starfish and octopus. A free RITA-to-LITAy-graft, with a LITA-to-left anterior descending coronary artery (LAD) and a free RITA-to-obtuse marginal or posterolateral or posterior descending artery, was constructed using the Trinity Clip. Patency was assessed with angiography (n = 3 anastomoses). Results The anastomotic procedure was feasible via a small lateral thoracotomy, with a fast construction of the y-graft, and successful application of the mounted complex (ie, graft, connector, and laser, temporarily fixated by a fixation clip) onto the LAD. Access to the obtuse marginal artery, posterolateral artery, and posterior descending artery was possible, with successful construction, resulting in patent anastomoses. Conclusions This experimental pilot study demonstrates the feasibility of the anastomotic technique in a total arterial minimally invasive direct coronary artery bypass approach. Revascularization of the anterior, lateral, and inferoposterior regions of the heart is possible. However, visibility during the introduction of the connector was limited, and videoscopic assistance is essential to allow for successful construction. The anastomotic technique has potential to facilitate minimally invasive coronary bypass surgery.

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Section: Discussionmentioning

confidence: 99%

Total Arterial Minimally Invasive Direct Coronary Artery Bypass Surgery Facilitated by the Trinity Clip Connector

Stecher

Bronkers²,

Hoefer

et al. 2015

Innovations�(Phila)

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“…D, Directly after the nonocclusive opening of the anastomosis, the distal end of the graft is ligated. Adapted with permission from Stecher et al 5 FIGURE 2. The Trinity Clip (A and B) and laser catheter (C).…”

Section: Methods Animalsmentioning

confidence: 99%

“…An outer band (3) provides safety and stabilization into the anastomotic connector. Adapted with permission from Stecher et al 5 connector and laser punches an opening into the graft (transmural, from intima to adventitia). 2.…”

Section: Methods Animalsmentioning

confidence: 99%

“…3,4 To target clinically relevant coronary arteries, recent modifications resulted in a downsized, oval laser and connectorVthe Trinity ClipVsuitable for coronary targets of 1.4 to 1.6 mm inner diameter (ID). 5 Application of the connector and opening of the anastomosis by the laser are both potentially affected by an atherosclerotic coronary artery. Therefore, before clinical introduction, we assessed the feasibility of the laser-assisted anastomotic technique on human diseased ex vivo coronary arteries in the first part of this study (study 1).…”

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confidence: 99%

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

Stecher

Bronkers²,

Vink

et al. 2016

Innovations�(Phila)

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Objective Atherosclerotic disease might hamper the efficacy of the Excimer laser-assisted Trinity Clip anastomotic connector in coronary arteries. Therefore, its efficacy was evaluated on human diseased coronary arteries (study 1). In addition, the acute laser effects onto the coronary wall were assessed (study 2). Methods Thirty-eight anastomoses were constructed on ex vivo human hearts. Atherosclerosis was histopathologically determined and subsequently related to the success of the technique (ie, connector positioning and laser punching; study 1). In addition, 20 anastomoses were constructed in an ex vivo (porcine, n = 8) and an in vivo [rabbit (n = 9) and porcine (n = 3)] model. Subsequently, the coronary was histologically studied on the presence of laser-induced damage (study 2). Results In 13 of 38 anastomoses (study 1), the connector was mal-positioned, 3 because of a severely diseased coronary wall and 10 because of an inner diameter less than the intended target range. The laser-punch success rates on coronary arteries with an early and advanced lesion were 100% (16/16) and 89% (8/9; lesions were located in the inferolateral wall), respectively. In one case, an advanced lesion (ie, fibrocalcified plaque) was located in the superolateral wall and caused a laser-punch failure. No histological signs of laser-induced damage were observed, in case of correct use (study 2). Conclusions This study demonstrates the feasibility of an anastomotic connector on human diseased coronary arteries and shows that lasering does not induce coronary wall damage. However, careful selection of the coronary, regarding the target inner diameter and disease status, will prevent construction failures. This connector could facilitate less invasive coronary artery bypass grafting.

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“…[ 133 148 ] Another laser-assisted anastomosis technique uses a Trinity Clip anastomotic connector to create an oval 0.8 × 2.0-mm end-to-side sutureless anastomosis that could feasibly be used for cerebrovascular bypass in the future. [ 132 ]…”

Section: Surgical Lasersmentioning

confidence: 99%

Laser application in neurosurgery

Belykh¹,

Yağmurlu²,

Martirosyan³

et al. 2017

Surg Neurol Int

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Background:Technological innovations based on light amplification created by stimulated emission of radiation (LASER) have been used extensively in the field of neurosurgery.Methods:We reviewed the medical literature to identify current laser-based technological applications for surgical, diagnostic, and therapeutic uses in neurosurgery.Results:Surgical applications of laser technology reported in the literature include percutaneous laser ablation of brain tissue, the use of surgical lasers in open and endoscopic cranial surgeries, laser-assisted microanastomosis, and photodynamic therapy for brain tumors. Laser systems are also used for intervertebral disk degeneration treatment, therapeutic applications of laser energy for transcranial laser therapy and nerve regeneration, and novel diagnostic laser-based technologies (e.g., laser scanning endomicroscopy and Raman spectroscopy) that are used for interrogation of pathological tissue.Conclusion:Despite controversy over the use of lasers for treatment, the surgical application of lasers for minimally invasive procedures shows promising results and merits further investigation. Laser-based microscopy imaging devices have been developed and miniaturized to be used intraoperatively for rapid pathological diagnosis. The multitude of ways that lasers are used in neurosurgery and in related neuroclinical situations is a testament to the technological advancements and practicality of laser science.

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Evaluation of a Novel Laser-assisted Coronary Anastomotic Connector - the Trinity Clip - in a Porcine Off-pump Bypass Model

Cited by 6 publications

References 30 publications

Total Arterial Minimally Invasive Direct Coronary Artery Bypass Surgery Facilitated by the Trinity Clip Connector

Total Arterial Minimally Invasive Direct Coronary Artery Bypass Surgery Facilitated by the Trinity Clip Connector

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

Laser application in neurosurgery

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