Unconventional vessel wall apposition in off-pump porcine coronary artery bypass grafting: Low versus high graft flow

Abstract

AbstractObjective: Facilitated coronary anastomosis techniques may involve unconventional vessel wall apposition in contrast to standard intima-intima apposition. We assessed the patency, anastomotic thrombus formation, and intimal hyperplasia of unconventional intima-adventitia apposition versus conventional suturing techniques in beating heart coronary bypass grafting under low versus high graft flow conditions. Methods: The intima-adventitia (n = 28) and conventional anastomoses (n = 28) were evaluated intraoperatively (n = 56), at 4 hours (n = 20), and at 5 weeks (n = 36) in a new off-pump low-flow (n = 28) and high-flow (n = 28) porcine bypass model (≤15 mL/min and about 60 mL/min, respectively). The anastomoses were assigned to the animals by means of randomized stratification and examined by means of flow measurements, angiography, and histology. Results: Mean graft flows in intima-adventitia and in conventional anastomoses were similar (P = .709). All but 1 of 56 anastomoses (low flow conventional) were fully patent at the time of death. At 4 hours, only small platelet depositions were found at the exposed media and adventitia in the unconventional anastomoses. At 5 weeks, little streamlining intimal hyperplasia was found, which was comparable between the anastomoses (P = .600). Conclusions: In low-flow conditions (≤15 mL/min) unconventional intima-adventitia apposition was not detrimental to the internal thoracic–coronary artery anastomosis in the pig. This finding may expand design strategies of facilitated coronary artery bypass anastomosis techniques