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Coronary anastomosis with mechanical sutures: the VCS
vascular clips. Initial experience.

Aramendi JI, Otero A, Martinez P.

Hospital de Cruces
Baracaldo, Spain

Abstract
Objectives
Methods
Results
Conclusions

Abstract
Objectives: to obtain a wide and easy to perform vascular anastomosis with the aid of mechanical sutures.
Methods: The VCS system (Autosuture) is an automatic stapling device that applies vascular clips with the shape of the African ant’s jaw. The clip stays entirely extravascular, hopefully producing no fibroblast proliferation. Due to its predetermined shape they grasp a minimal bite of the vessel border in an everting fashion, therefore allowing an anastomosis as wide as possible. The wall of the grafted vessel must be flexible and exempt of calcifications.
Results: our initial experience consists in 3 cases that underwent coronary a. bypass grafting. One patient was operated without the aid of cardiopulmonary bypass and the other 2 with CPB. 5 out of 8 distal anastomosis were done with the VCS clips, 3 saphenous v. grafts and 2 LIMA grafts. 2 stay sutures of Prolene were applied at the heel and toe of the anastomosis to facilitate exposure. The last patients had all the distal anastomosis performed with VCS clips. No mortality nor complications resulted from the use of this device.
Conclusions: the VCS clips permits to perform a wider anastomosis that with conventional suture. With experience it can be easily and quickly done. It can be an important tool for minimally invasive surgery and by avoiding sutures and knots it can be it can be an important step towards endoscopical anastomosis.

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Objectives:

To obtain a wide and easy to perform vascular anastomosis with the aid of mechanical sutures.

Methods:

The VCS system (Autosuture) is an automatic stapling device that applies vascular clips with the shape of the African ant’s jaw. The clip stays entirely extravascular, hopefully producing no fibroblast proliferation. Due to its predetermined shape they grasp a minimal bite of the vessel border in an everting fashion, therefore allowing an anastomosis as wide as possible. The wall of the grafted vessel must be flexible and exempt of calcifications.

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Figure 1: end to side anastomosis 1

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Figure 2: technique of clipping 1

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Results:

Our initial experience consists in 3 cases that underwent coronary a. bypass grafting. One patient was operated without the aid of cardiopulmonary bypass and the other 2 with CPB. 5 out of 8 distal anastomosis were done with the VCS clips, 3 saphenous v. grafts and 2 LIMA grafts. 2 stay sutures of Prolene were applied at the heel and toe of the anastomosis to facilitate exposure. The last patients had all the distal anastomosis performed with VCS clips. No mortality nor complications resulted from the use of this device

Case #1 Case # 2 Case # 3
Off-pump case Conventional CPB Conventional CPB
saphenous v to RCAwith VCS clips

Saphenous v. to intermidiate a. VCS

Saphenous v. to intermidiate a. VCS
LIMA to LAD conventional LIMA to LAD VCS LIMA to LAD VCS
  Saphenous v to RCA conventional Saphenous v to RCA VCS
  Ischemic time 60 min Ischemic time 46 min

No Mortality nor Complicatios

Control cardiac catheterisation was performed in case #3 showing patency of the anastomoses with excellent runoff antegrade and retrograde. Actually, the size of the anastomosis was greater than the size of the grafted coronary artery.

Conclusions:

The VCS clips permits to perform a wider anastomosis that with conventional suture. With experience it can be easily and quickly done. It can be an important tool for minimally invasive surgery and by avoiding sutures and knots it can be an important step towards endoscopical anastomosis.

 

Questions, contributions and commentaries to the Authors: send an e-mail message (up to 15 lines, without attachments) to surgery-pcvc@pcvc.sminter.com.ar , written either in English, Spanish, or Portuguese.

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© CETIFAC
Bioengineering
UNER

Update
Nov/13/1999