| P308 | Facilitated Endoscopic Beating Heart Coronary Bypass Grafting Using Distal Anastomotic Devices. |
| S.Jacobs, V.Falk, F.W.Mohr | |
| Herzzentrum Leipzig, Leipzig. | |
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Background Suturing of a coronary anastomosis is still a barrier for evolution in totally endoscopic coronary artery bypass grafting (TECAB) on the beating heart. This trail provides the potential benefits of endoscopic distal anastomotic devices including the MVP and the St. Jude Medical Anastomotic device to facilitate construction of a coronary anastomosis in a closed chest environment. Methods TECAB on the beating heart was performed in 11 FBI dogs with the daVinci telemanipulation system (Intuitive Surgical, Mountain View, CA). Two prototypes of an endoscopic distal anastomotic device, the MVP (Ventrica, Inc, Fremont, CA) and the St. Jude Medical (St. Jude Medical, Inc, Maple Grove, MI) were used to facilitate construction of the coronary anastomosis. One pair of magnets (MVP) were inserted in the ITA and LAD in 8 dogs and a pair of stainless steel rings were inserted trough the ITA in the LAD with a guidewire (St. Jude Medical) in three dogs to perform the anastomosis. Robotic instruments guided and placed the endoscopic delivery systems. All animals underwent angiography; gross inspection of the anastomotic site was performed after excision of the hearts. Results The procedure was accomplished in all animals in 187 minutes (145-211).The anastomosis were easily accomplished in 6 minutes (1-28) using the MVP Device and 11 minutes (8-13)using the St. Jude Medical Device. 8/11 animals with a patent graft and anastomosis survived the procedure. Over all patency was 10/11. Discussion The combination of robotic technology allowing for dexterous manipulation in a closed chest environment and simple yet effective and time saving techniques for anastomotic coupling may facilitate beating heart TECAB. |