New device for saphenous vein-to-aorta proximal anastomosis without side-clamping

Ernesto Tappainer

doi:10.1186/1749-8090-2-22

Abstract

BackgroundSide clamping to perform saphenous vein-to-aorta proximal anastomosis is a well known cause of cerebral embolization during coronary bypass surgery. Automatic and manual devices have been introduced to avoid aortic clamping and facilitate proximal anastomosis but the manual ones only allow the traditional hand-sewing running suture. Nevertheless, they are not easy to use and very expensive to buy.MethodsWe developed a simple object that helps to perform a manual proximal anastomosis without the need to clamp the side of the aorta. This device is a steel bar which blocks the aortic hole and simultaneously it provides a slit to receive the needle. Through the slit comes out a thin, sharp, straight, but also well directed and predictable jet of blood which could be easily controlled during the suture.ResultsThe function of the object is quite different from other devices. Nothing is deployed in the aorta. The object is only placed on the aorta with the small appendage slipped into the hole. The main advantage of the device is that while manipulation of the aorta is avoided no foreign bodies are incorporated in the suture and – most importantly – the aortic intima is not touched at all. The main drawback of the device is the blood jet coming from the slit so that the blood pressure has to be lowered by vasodilators during the anastomosis. Moreover, the suture has to change direction and the needle has to enter the aortic wall first to slip out through the slit.ConclusionThe object was named "Slit Device" and is not a routine instrument. It would be only an alternative to other anastomotic devices with the same surgical indications. In the case of ascending aortic disease and saphenous vein grafting, the Slit Device avoids aortic clamping thereby preventing atheroembolism and also avoiding the need for hypothermic circulatory arrest in patients with unclampable aorta.

Highlights

Side clamping to perform saphenous vein-to-aorta proximal anastomosis is a well known cause of cerebral embolization during coronary bypass surgery
In cases of vein-to-aorta proximal anastomosis it is obtained by a partial occluding, side-biting clamp on the aortic wall (Figure 1)
I thought that in critical cases of unclampable aorta rather than go to a hypothermic circulatory arrest otherwise required in these patients [11], I could try to perform the anastomosis even if a stream of blood flowed through the lateral furrow of the bar

Summary

Introduction

Side clamping to perform saphenous vein-to-aorta proximal anastomosis is a well known cause of cerebral embolization during coronary bypass surgery. Automatic and manual devices have been introduced to avoid aortic clamping and facilitate proximal anastomosis but the manual ones only allow the traditional hand-sewing running suture. They are not easy to use and very expensive to buy. In cases of vein-to-aorta proximal anastomosis it is obtained by a partial occluding, side-biting clamp on the aortic wall (Figure 1) Sometimes atherosclerosis makes it difficult with a high risk of atheroembolism. The increasing age of patients increases the risk of embolization because of more extensive vascular alterations in older patients [3]

Methods

Results

Conclusion