TEMPORARY LUMINAL ARTERIOTOMY SEAL FOR BYPASS-GRAFTING

Background. To enable off-pump coronary operations in a bloodless surg ical field without ischemic complications, we developed and assessed a temporary luminal arteriotomy seal in a porcine carotid artery bypass graft model. Methods. In 16 consecutive pigs (25 kg, 32 anastomoses) the arteriotomy was sealed luminally by a polyurethane elliptic convex seal. Endothelial denudation, medial necrosis, and intimal hyperplasi a were measured quantitatively and compared with those seen in convent ionally sutured anastomoses. Results. The median occlusive time upon i nsertion or retrieval was 90 and 82 seconds, including the arteriotomy and securing the anastomosis, respectively. Once properly positioned, the seal provided a bloodless arteriotomy in all anastomoses. Microsu rgical suturing was performed without leakage of the seal and with uni mpeded flow. In the recipient artery, endothelial denudation was limit ed to one third of its circumference. No medial necrosis was found. In timal hyperplasia at heel and toe was not significantly different from that seen in conventionally sutured anastomoses. Conclusions. During end-to-side bypass grafting, the temporary luminal arteriotomy seal pr ovided a bloodless surgical field without interfering with recipient a rtery blood flow and with minimal damage to the arterial wall. (C) 199 8 by The Society of Thoracic Surgeons.