Arteriotomy closure by glued patch in the porcine carotid artery

Background. A thoracoscopic approach to coronary bypass grafting warrants r enewed search for facilitated vascular anastomosis methods. We reassessed t issue adhesion, sealing properties, and histotoxicity of iso-butyl-cyanoacr ylate, in a simplified anastomosis model. Methods. In 12 Dutch landrace pigs, five arteriotomies were made in each ca rotid artery. The arteriotomies were closed by conventional microvascular s uturing or by pericardial patch (Peri-Strips) and iso-butyl-cyanoacrylate. The animals were sacrificed at 2 hours (n = 2), 2 days (n = 5), and 4 weeks (n = 5). The arteries were examined by flow measurement, angiography, and histologic analysis. Results. The time required to close arteriotomies by conventional suturing was 257 +/- 43 seconds (mean +/- SD) and by glued patch 51 +/- 27 seconds ( p < 0.001). In all arteriotomies covered by glued patch, complete hemostasi s was obtained. At 2 days and 4 weeks, with both methods the same histologi c results were observed. At follow-up, all carotid arteries were patent wit hout stenoses. Conclusions. Arteriotomy closure by glued patch was simple, fast, reliable, and without signs of histotoxicity. Adhesives deserve to be reconsidered a s an alternative to suturing in closed chest beating-heart coronary surgery . (C) 2000 by The Society of Thoracic Surgeons.