Magnetic Vascular Port in Minimally Invasive Direct Coronary Artery Bypass Grafting

Abstract

Background-Minimally invasive direct coronary artery bypass grafting (MIDCAB) is a well-established operative procedure. However, it is technically demanding and is therefore somewhat underused. We evaluated the clinical and angiographic outcome of patients undergoing a MIDCAB procedure with the Ventrica Magnetic Vascular Port (MVP®) system. Methods and Results-A Ventrica MVP® system was used in 10 of 11 selected MIDCAB patients. The system consists of 6 magnetic clips, with 3 clips forming a set. One magnetic clip set is positioned at the arteriotomy of the target artery and of the bypass graft using a preloaded delivery system. These ports then form an anastomosis by magnetic coupling. The mean age of the 10 patients (6 male) was 60.3Ϯ11.0 years. Three patients had an angiogram at the time of discharge and 8 returned for a 6-month angiogram. The total procedure time was 128.2Ϯ12.2 minutes. The mean anastomotic time was 199 seconds. The mean ischemic time during the anastomosis was 146Ϯ146 seconds. There were no in-hospital complications and no device-related adverse events. All 3 predischarge and all 8 6-month angiograms showed patent anastomoses. Conclusions-The magnetic vascular port facilitates the MIDCAB procedure significantly and reduces the ischemic time during the anastomosis. This minimally invasive procedure has the potential to be an alternative to percutaneous transluminal coronary angioplasty and stenting in proximal left anterior descending (LAD) stenosis. It may expand the acceptance of hybrid procedures in which a left internal mammary artery (LIMA)-to-LAD graft optimally supplies the anterior wall and the septum while the circumflex and right coronary artery may be treated interventionally.

MRI-Based Safety Evaluation of the Ventrica Magnetic Coronary Anastomotic System

“…The clinical performance, special individual considerations, and the outcome following application, especially postoperative angiography, have been well described by us and others. [3][4][5][6] With increasing popularity of such devices and intense worldwide demand for less invasive approaches in cardiac surgery, automatic anastomotic devices are most likely to be used in a routine clinical fashion in the near future. However, before their routine application, many important questions regarding the safety of these instruments should be answered.…”

“…In a subsequent study, we described a series of patients undergoing MIDCAB with a single LITA-to-left anterior descending artery (LAD) anastomosis utilizing the MVP system. 6 Since our initial experience, we have evaluated the safety of the device when used with an anti-platelet regimen, before recommending its routine clinical use. 4 The effect of intense magnetic fields, as applied during postoperative magnetic resonance imaging (MRI), on these magnetic anastomoses has not been evaluated.…”

Exploration and establishment of magnetic surgery

“…使用领域 磁体外环境 MCT 血管侧侧吻合 [36] 、胃肠吻合 [64] 、小肠吻合 [76] 、结肠吻合 [67] 、膀胱造瘘 [77] 、食管狭窄/ 闭锁再通 [8] 、胆道狭窄/闭锁再通 [20] 、胆肠吻合 [23] 、胰肠吻合、消化道造瘘 [78] 、消化 道瘘口修补 [46] 、抗胃食管返流 [68] 、血管端端吻合 [39] 等…”

Nouveautés et perspectives dans le domaine des sutures et des ligatures chirurgicales

“…Ce système a déjà été utilisé avec succès en chirurgie cardiaque pour réaliser des pontages coronaires. Ils présentent les mêmes avantages que le laser cité ci-dessus, à savoir le gain de temps et la perfection de l'anastomose (26,27). Concernant les techniques, le débat porte surtout sur la parade à l'incongruence des vaisseaux.…”