Sutureless techniques bolster speed, precision in bypass surgery

November 11, 2001

ANAHEIM, Calif., Nov. 12 - Putting patients on a heart-lung machine while doctors manually stitch blood vessels to coronary arteries could soon become history, according to two studies of sutureless surgical techniques presented today at the American Heart Association's Scientific Sessions 2001 conference.

Sutureless techniques can allow simpler, more exact connections of blood vessels and shorten the time patients spend on the heart-lung machine during coronary artery bypass surgery, researchers say. These techniques may prove useful as surgeons refine methods for minimally invasive surgery on the beating heart, eventually dispensing with the heart-lung machine, they say. Most coronary bypass graft operations use a heart-lung machine to keep blood and oxygen flowing to the body while the heart and lungs are stopped. Because the heart muscle is deprived of blood and oxygen at this time, some heart damage may occur. During conventional bypass surgery, surgeons take a blood vessel from another part of the body and construct a detour around the blocked segment of the coronary artery. One end is sewn onto the large artery leaving the heart - the aorta. The other end of the vessel is attached or "grafted" to the coronary artery below the blocked area. Some surgeons say that hand stitching this end of the bypass vessel is more difficult than making the connection with the aorta.

In two studies of different techniques, independent research teams reported the first results in sutureless vascular graft surgery. One technique uses a new stainless steel device with an expandable clip that balloons out to connect the bypass vessel to the coronary artery. The new device has external hooks that hold the vein graft in place while internal hooks secure the inside of the artery. With this technique, blood vessels were connected in less than two minutes, compared to an average of five to seven minutes with a traditional hand-stitching connection.

"This technique is very exciting," says Friedrich Stefan Eckstein, M.D., the study's lead investigator and a cardiovascular surgeon at University Hospital in Berne, Switzerland. "This is the first investigational clip device devised for coronary artery surgery."

Eckstein and his colleagues reported results in the first 13 patients undergoing coronary artery bypass surgery with this sutureless technique, which reduced operating time and shortened the time patients were on a heart-lung machine. "Another advantage is that the sutureless technique permits a more consistent connection between the blood vessels and could be used in bypass operations without a heart-lung machine or even in minimally invasive coronary surgery," Eckstein notes.

In the second study, researchers tested a new mechanical device that uses an adhesive material to connect and seal blood vessels in coronary artery bypass surgery. The technique was tested in pigs undergoing experimental coronary bypass surgery. Thirty-five days after surgery, the blood vessels were fully sealed with excellent blood flow through them, according to Marc P. Buijsrogge, M.D., who led the study.

"First, this is a fast and very easy way to connect heart vessels, and therefore an attractive alternative to the current sewing technique," says Buijsrogge, a research fellow at the Heart Lung Center at University Medical Center in Utrecht, Netherlands.

Another benefit of this technique, besides making a quick and reliable connection, is that it was possible to perform the procedure on the beating heart without having to put the animals on a heart-lung machine, he says. Instead, they accessed the target coronary artery with a tissue stabilizing device. The device consists of two suction paddles that adhere to the surface of the heart just parallel to the target vessel and immobilize the site for performing the bypass. With further development, Buijsrogge says the technique could prove a viable alternative to traditional bypass.

This particular research is clearly preliminary and will require further refinements before it is used on human patients undergoing cardiac surgery, Buijsrogge says. However, the quality of the graft connections in the animal procedures was comparable with traditional bypass surgery a few weeks after grafting.

Both researchers think the new techniques will eventually play a role in minimally invasive cardiovascular surgery. Eckstein foresees customizing the connector device so that blood vessels of different sizes can be connected. Both investigators say this technology could ultimately facilitate robotic surgery.
Co-authors with Dr. Eckstein are: Luis F. Bonilla, M.D.; Beat Meyer, M.D.; Peter P. Neidhart, M.D.; Jurg Schmidli, M.D.; and Thierry P. Carrel, M.D.

Co-authors with Dr. Buijsrogge's are: Jules S. Scheltes, M.Sc.; Martijn Heikens, B.Sc.; Paul F. Gründeman, M.D., Ph.D.; and Cornelius Borst, M.D., Ph.D.

NR01 - 1368 (SS01/Eckstein/Buijsrogge)

8:30 a.m. PST, Sunday
November 11, 2001
(Note: This will be included in a news conference on Sunday)

For information Nov. 10-14, contact Bridgette McNeill or Carole Bullock at the Hilton Anaheim Hotel
(714) 251-5801

Abstracts 1727 & 1728

American Heart Association

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