Quality assessment of distal S2AS connector anastomosis by 13MHz epicardial ultrasound

Budde, Ricardo P.J.; Suyker, Willem J.L.; Suyker, Paul T.W.; Verlaan, Cees W.J.; Meijer, Rudy; Borst, Cornelius; Gründeman, Paul F.

doi:10.1016/j.ejcts.2005.08.020

Cited by 3 publications

(4 citation statements)

References 12 publications

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“…Intraoperative anastomosis quality assessment may aid in the introduction of novel automated distal anastomosis connectors developed to facilitate the suturing process in minimally invasive approaches [43][44][45]. In the off-pump CABG pig model, ECUS was successfully used for quality assessment of a coronary connector anastomosis [45].…”

Section: Coronary Connector Anastomosismentioning

confidence: 99%

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High-frequency epicardial ultrasound: review of a multipurpose intraoperative tool for coronary surgery

et al. 2008

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Background In open-chest coronary artery bypass grafting (CABG), the surgeon faces several intraoperative challenges: (1) to locate the target coronary artery, (2) to select the optimal anastomotic site, and (3) to assess the quality of the graft and distal anastomosis. Endoscopically, these three diagnostic aims are particularly challenging. Methods We reviewed the literature on the intraoperative application of high-frequency (6.5-15 MHz) epicardial ultrasound (ECUS) in CABG to aid in these challenges. Results Overall, ECUS was used in 628 patients to visualize and assess 912 (segments of) coronary arteries, as well as 418 grafts and distal anastomoses. In 96 cases, ECUS successfully located a coronary artery that was buried in the epicardial and/or myocardial tissue. In 37/155 (24%) imaged anastomotic sites, an alternative site free of pathology was selected. For quality assessment of the coronary anastomosis, experimental validation of ECUS included 218 anastomoses in ex vivo and animal models. ECUS showed high sensitivity (0.98) and specificity (1.00) for detection of anastomotic construction errors in 120 ex vivo anastomoses. In 418 grafts and distal anastomoses evaluated in patients, irregularities leading to revision were detected in 8 (1.9%) anastomoses and minor irregularities in an additional 23 (5.5%) anastomoses. However, little is known about the effect on long-term patency of specific anastomotic abnormalities revealed by ECUS. Scanning of arteries and anastomoses required several minutes. Current size ultrasound probes allowed successful experimental robot-assisted endoscopic application of ECUS. Conclusions CABG may be facilitated and improved in several ways by intraoperative high-frequency epicardial ultrasound scanning. Totally endoscopic CABG may benefit from ultrasound diagnostics in particular.

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Section: Coronary Connector Anastomosismentioning

confidence: 99%

“…In the off-pump CABG pig model, ECUS was successfully used for quality assessment of a coronary connector anastomosis [45]. Connectors that contain a substantial amount of metal [43], however, may generate too many imaging artefacts to allow adequate assessment of anastomosis geometry.…”

Section: Coronary Connector Anastomosismentioning

confidence: 99%

High-frequency epicardial ultrasound: review of a multipurpose intraoperative tool for coronary surgery

et al. 2008

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“…Coronary connectors may advance TECAB as well by providing a means to facilitate anastomosis construction and omit the tedious suturing process (Falk et al, 2003). ECUS can be used for size matching and quality assessment of some of the connectors (Budde et al, 2005).…”

Section: Future Of Tecabmentioning

confidence: 99%

Robot-Assisted Epicardial Ultrasound for Coronary Artery Localization and Anastomosis Quality Assessment in Totally Endoscopic Coronary Bypass Surgery

Budde¹,

Borst²,

Bakker³

et al. 2008

Medical Robotics

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“…6 LITA blood flow was measured with a calibrated transit time flow probe (size 3S) connected to a flowmeter (T208; Transonic Systems Inc, Ithaca, NY) at a mean blood pressure of 80 mm Hg.…”

Section: Hand-sutured Anastomotic Proceduresmentioning

confidence: 99%

S ² Connector Versus Suture

et al. 2006

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Background-Anastomotic connectors could be the key to less invasive bypass surgery, including endoscopic procedures, but equivalence to conventional suturing needs to be established. A novel distal coronary connector was tested pre-clinically for safety and efficacy in comparison to conventional suturing. Methods and Results-Left internal thoracic to left anterior descending coronary artery bypasses were constructed off-pump in 35 pigs (73Ϯ8 kg). An intraluminal metal connector (S 2 AS) was used in 21 and conventional suturing in 14 animals. S 2 AS anastomosis construction was easier achieved in one-fourth of the conventional construction time (3.7Ϯ0.7 versus 16.5Ϯ2.6 minutes; PϽ0.001). Acute patency tended to be better (Pϭ0.15). All anastomoses were evaluated intraoperatively, and subgroups at 90 and at 180 days. Patency was 100%. An effective remodeling response was observed in all groups, resulting in unobstructed anastomoses with excellent hemodynamic performance (fractional flow reserve Ն0.93 at 180 days). At 6 months, the noncompliant connector was covered with stabilized neointima that was thinner than found on the suture line (0.10Ϯ0.04 versus 0.31Ϯ0.13 mm; Pϭ0.01). The connector induced less lumen loss (Ϫ0.6Ϯ6.5 versus 21.6Ϯ19%; Pϭ0.03). The initial side-to-side configuration had remodeled to an end-to-side shape as intended. Conclusions-In the porcine model, the connector rapidly and consistently produced high-quality anastomoses that fully met current standards on patency and function. Unconventional aspects like a noncompliant intraluminal ring and a side-to-side to end-to-side converted configuration did not interfere with favorable anastomosis remodeling. These findings shed a new light on the anatomical prerequisites for anastomosis patency.

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Quality assessment of distal S2AS connector anastomosis by 13MHz epicardial ultrasound

Abstract: In the pig, external caliper measurements provided a reliable quantitative estimate of inner graft and coronary diameter for connector size matching. Epicardial 13 MHz ultrasound is a promising method to assess coronary anastomosis quality even when connector metal is present.

Cited by 3 publications

References 12 publications

High-frequency epicardial ultrasound: review of a multipurpose intraoperative tool for coronary surgery

High-frequency epicardial ultrasound: review of a multipurpose intraoperative tool for coronary surgery

Robot-Assisted Epicardial Ultrasound for Coronary Artery Localization and Anastomosis Quality Assessment in Totally Endoscopic Coronary Bypass Surgery

S ² Connector Versus Suture

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Quality assessment of distal S2AS connector anastomosis by 13MHz epicardial ultrasound

Abstract: In the pig, external caliper measurements provided a reliable quantitative estimate of inner graft and coronary diameter for connector size matching. Epicardial 13 MHz ultrasound is a promising method to assess coronary anastomosis quality even when connector metal is present.

Cited by 3 publications

References 12 publications

High-frequency epicardial ultrasound: review of a multipurpose intraoperative tool for coronary surgery

High-frequency epicardial ultrasound: review of a multipurpose intraoperative tool for coronary surgery

Robot-Assisted Epicardial Ultrasound for Coronary Artery Localization and Anastomosis Quality Assessment in Totally Endoscopic Coronary Bypass Surgery

S 2 Connector Versus Suture

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S ² Connector Versus Suture