Mechanical strength and hydrostatic testing of VIVO adhesive in sutureless microsurgical anastomoses: an ex vivo study

Abstract

Conventional anastomoses with interrupted sutures are challenging and inevitably associated with trauma to the vessel walls. The goal of this study was to evaluate a novel alternative adhesive-based suture-free anastomosis technique that uses an intraluminal stent. Overall, 120 porcine coronary vessels were analyzed in an ex vivo model and were examined for their mechanical (n = 20 per cohort) and hydrostatic strength (n = 20 per cohort). Anastomoses were made using the novel VIVO adhesive with an additional intraluminal nitinol stent and was compared to interrupted suture anastomosis and to native vessels. Sutureless anastomoses withstood pressures 299 ± 4.47 [mmHg] comparable to native vessels. They were performed significantly faster 553.8 ± 82.44 [sec] (p ≤ 0.001) and withstood significantly higher pressures (p ≤ 0.001) than sutured anastomoses. We demonstrate that the adhesive-based anastomosis can also resist unphysiologically high longitudinal tensile forces with a mean of 1.33 [N]. Within the limitations of an in vitro study adhesive-based suture-free anastomosis technique has the biomechanical potential to offer a seamless alternative to sutured anastomosis because of its stability, and faster handling. In vivo animal studies are needed to validate outcomes and confirm safety.

Novel In Vitro Study to Assess Microbial Barrier Properties of Polyurethane-Based Tissue Adhesives in Comparison to the Gold Standard Dermabond®

“…It is mentioned that this mechanism of action is due to the strong electronegative charge on the cyanoacrylate monomer that reacts with the positively charged carbohydrate capsule of Gram-positive organisms [ 36 , 37 ]. The polyurethane-based tissue adhesive was previously evaluated in an ex vivo study showing good tensile strength in suture-less microsurgical anastomoses [ 38 ]. Other in vivo studies also showed that it can be a good candidate as a reinforcement for blood vessel anastomoses in a secure and less traumatic manner [ 28 , 39 ].…”

Evaluation of the long‐term results of vascular anastomosis using polyurethane adhesive and shape‐memory stent in the rat carotid artery model

“…VIVO showed a fast polymerization and was able to induce a significantly faster sealing with a bleeding time of about 3 min compared with fibrin glue, with a bleeding time of about 10 min (Tanaka et al, 2017). Furthermore, in vitro porcine coronary studies on sutureless microsurgical anastomoses with VIVO showed that the adhesive could withstand pressures up to 299 mmHg, which was found to be comparable to native vessels (Heitzer, Brockhaus, et al, 2021). In a rat study, microsurgical anastomoses with VIVO and two additional sutures in the carotid artery demonstrated 100% overall patency rate over a 2‐h period, with no evidence of stenosis or invasion of adhesive into the vessels lumen (Heitzer, Mohlhenrich, et al, 2021).…”

“…Other promising synthetic adhesives that are being investigated in preliminary studies are adhesives based on polyurethanes (Fukushima et al, 2018; Heitzer, Brockhaus, et al, 2021; Heitzer, Mohlhenrich, et al, 2021; Tanaka et al, 2017). These polymers consist of two main components: Isocyanates and polyols.…”

A polyurethane‐based surgical adhesive for sealing blood vessel anastomoses—A feasibility study in pigs

“…It was designed to polymerizes quickly with the aid of a curing agent to overcome the above‐mentioned downsides. This adhesive already demonstrated sufficient burst and tensile strength in sutureless microsurgical anastomoses in an ex vivo setting 19 . Furthermore, it was used in combination with a temporary intraluminal catheter or a nitinol stent in an in vivo rat model to develop faster, easier, more secure and less traumatic methods for microvascular anastomoses 20 …”

“…This adhesive already demonstrated sufficient burst and tensile strength in sutureless microsurgical anastomoses in an ex vivo setting. 19 Furthermore, it was used in combination with a temporary intraluminal catheter or a nitinol stent in an in vivo rat model to develop faster, easier, more secure and less traumatic methods for microvascular anastomoses. 20 In the present study, the adhesive is further investigated using a porcine animal model to achieve a higher comparability to the human.…”