INTERNAL MAMMARY CORONARY-ARTERY ANASTOMOSIS BY CO2-LASER - AN ACUTE EXPERIMENTAL-STUDY

被引：5

作者：

BASU, S ^{[1
]}

MARINI, CP ^{[1
]}

COONS, MS ^{[1
]}

WOLOSZYN, TT ^{[1
]}

FOLLIGUET, TA ^{[1
]}

BAUMANN, FG ^{[1
]}

JACOBOWITZ, IJ ^{[1
]}

机构：

[1] SUNY HLTH SCI CTR,MAIMONIDES MED CTR,DEPT SURG,DIV CARDIOVASC & THORAC SURG,4802 10TH AVE,BROOKLYN,NY 11219

来源：

JOURNAL OF CARDIAC SURGERY | 1991年 / 6卷 / 02期

关键词：

D O I：

10.1111/j.1540-8191.1991.tb00311.x

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

This study was designed to determine the feasibility of anastomosing the internal mammary artery (IMA) and coronary artery with a carbon dioxide laser in a canine model. Twenty-two mongrel dogs were randomly assigned to two groups: group I (n = 11) underwent laser-assisted vascular anastomosis (LAVA) of the left IMA to the left anterior descending (LAD) coronary artery, whereas in group II (n = 11) the anastomosis was done with the conventional technique (handsewn). Laser methodology was used to micro-weld vessels utilizing a power of 200 mW with a spot size of 500-mu, producing an effective power density of 102 W/cm2 and energy fluence of 9,172 joules/cm2 in a continuous mode at a distance of 2 cm. The short-term patency rate, measured at 2 hours after completion of the anastomosis, was 100% in both groups. The time required to perform the LAVA in group I was significantly shorter than group II (6.27 +/- 0.47 vs 11.6 +/- 0.67 min, p < 0.05). The mean anastomotic bursting pressure in group I was significantly lower compared to group II (348 +/- 8 vs 402 +/- 9 mmHg, p < 0.05). Histologic evaluation of all vessels showed moderate thermal injury of the adventitia and media in the laser group. Scanning electron microscopy exhibited a smooth anastomotic area in group I, whereas endothelial and perianastomotic changes with multiple needle craters occurred in group II (conventional anastomosis). Based on the results of this study, we conclude that a low powered CO2 laser can be used to safely perform an IMA to LAD artery anastomosis, thus providing an alternative to conventional techniques because of its rapidity and minimization of anastomotic changes.

引用

页码：286 / 293

页数：8

共 17 条

[1]

Jain KK, Gorisch W, Repair of small vessels by neodymium‐yag laser: A preliminary report, Surgery, 85, (1979)

[2]

Morris JR, Carter M, (1980)

[3]

Neblett C, Morris J, Thomson S, Laser‐assisted microvascular anastomosis, Neurosurgery, 19, (1986)

[4]

Basu S, Jacobowitz IJ, Wang S, Et al., Microvascular anastomosis using CO<sub>2</sub> laser and conventional suture technique, Surg Forum, 38, (1987)

[5]

MaCarthy WJ, Hartz RS, Yao JST, Et al., Vascular anastomosis with laser energy, Journal of Vascular Surgery, 3, (1986)

[6]

White R, White G, Fujitani R, Et al., Initial human evaluation of argon laser‐assisted vascular anastomosis, J Vasc Surg, 9, (1989)

[7]

White R, Technical frontiers for the vascular surgeon: Laser anastomotic welding and angios‐copy‐assisted intraluminal instrumentation, J Vasc Surg, 5, (1987)

[8]

Galbut DL, Traad EA, Dorman MJ, Et al., Twelve years experience with bilateral internal mammary grafts, Ann Thorac Surg, 40, (1985)

[9]

Loop FD, Lytle BW, Cosgrove DL, Et al., Influence of internal mammary artery graft on 10 year survival and other cardiac events, N Engl J Med, 314, (1986)

[10]

Basu S, Wang S, Robertazzi R, Et al., In vitro bursting strength studies of laser welded tissue and comparison with conventional anastomosis, J Vasc Surg, 7, (1988)

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