Temporary luminal arteriotomy seal:: II.: Coronary artery bypass grafting on the beating heart

Background. This study assessed the feasibility of applying a temporary luminal arteriotomy seal during end-to-side coronary artery bypass grafting on the beating heart. Methods. In 18 consecutive pigs, the left internal mammary artery wa's grafted to the left anterior descending coronary artery, and the arteriotomy was temporarily sealed luminally by a 200-mu m-thick polyurethane seal. Endothelial denudation, medial necrosis, and intimal hyperplasia were measured quantitatively and compared with conventionally sutured anastomoses (n = 4 pigs). Results. Insertion and retrieval of the seal required 28 +/- 12 and 11 +/- 6 seconds, respectively. Including the arteriotomy, coronary artery occlusion was limited to about 80 seconds. The seal provided a bloodless arteriotomy in all anastomoses with unimpeded coronary artery blood now. Endothelial denudation was limited to two thirds of the circumference of the coronary artery. No medial necrosis was found. Intimal hyperplasia at the suture line was small, although more pronounced when compared with conventionally sutured anastomoses. Conclusions. In off-pump, beating-heart coronary artery bypass grafting, the temporary luminal arteriotomy seal provided a bloodless arteriotomy with negligible obstruction to coronary artery blood now, and with a minimum of arterial wall damage. It is conceivable that this seal may expand the indications for coronary surgical procedures without cardiopulmonary bypass. (C) 1998 by The Society of Thoracic Surgeons.