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The purpose of this study was to examine the feasibility of the combined use of intraluminal biodegradable shunts and surgical adhesives for sutureless distal coronary anastomosis. Eighteen LITA-LAD anastomoses were created in a porcine beating heart model. In group I (n=9) a custom-made silicone Y-shunt provided internal stability, while three different adhesives, N-butyl-2-cyanoacrylate-glue (CYAC); albumin-glutaraldehyde-glue (AG); fibrin-glue (FIB), were applied externally. In group II (n=9) biodegradable polydioxanone (PDS) shunts were used. All anastomoses were examined intraoperatively by flow measurement, blood leakage was quantified and physical strength was tested. In all pigs anastomoses could be created successfully at first attempt, but anastomotic leaks requiring additional sutures occurred in 6 animals. LITA-flow significantly decreased in both groups. A patency rate of 89.9% (8/9) was found in group I while it was 66.6% (5/9) in group II. The lowest amount of blood-loss was measured when CYAC adhesive was used while tensile strength was lowest in the FIB-anastomoses. Preliminarily we could demonstrate the feasibility of performing sutureless distal coronary anastomosis by means of a combination of adhesives and temporary intraluminal shunts. PDS-shunts, however, resulted in a high graft-occlusion rate, so that potentially less thrombotic materials need to be investigated.

Objective: Adhesives are useful supplements to seal distal coronary anastomoses, particularly in patients who receive less-invasive coupling techniques. Information regarding long-term structural effects after application, however, is limited. The purpose of this large animal study was to examine the effects of 3 different commercially available surgical adhesives., Methods: Twelve end-to-side anastomoses were created between the left internal thoracic artery and the left anterior descending coronary artery in a porcine beating heart model. Three different adhesives were applied externally and circumferentially to the anastomosis site. In group I (n = 4) gelatin-resorcinol-formaldehyde glue (Cardial, Technopole, Sainte-Etienne, France), in group II (n = 4) n-butyl-2-cyanoacrylate glue, and in group III (n = 4) albumin-glutaraldehyde glue were used. All anastomoses were examined intraoperatively by flow measurement. After 3 months the anastomoses were reassessed for patency and the vessels were evaluated histologically., Results: By means of 4 stay sutures and subsequent glue application, anastomoses could be created successfully on the first attempt in all animals. Perioperative flow through the left internal thoracic artery was similar in all groups. In 4 animals an additional suture was placed to control bleeding. After 3 months, the patency rate was 83.3% (10/12). In group I all anastomoses were patent whereas in both groups II and III one anastomosis was occluded. None of the adhesives caused impaired vessel wall healing but they did demonstrate moderate-to-dense adhesions to the surrounding tissue. On histologic examination, gelantin-resorcinol-formaldehyde glue exhibited minimal tissue reaction (foreign-body granuloma) whereas n-butyl-2-cyanoacrylate glue showed moderate reaction. In contrast, albumin-glutaraldehyde glue caused severe inflammatory reaction with extensive fibroblastic proliferation., Conclusion: Construction of an end-to-side internal thoracic artery-coronary artery sleeve anastomosis using adhesives was feasible in the pig. Among the tissue adhesives used in this study, gelantin-resorcinol-formaldehyde glue appeared to be superior to cyanoacrylate and albumin-glutaraldehyde glue. The latter one, however, caused severe adverse histologic effects and thus cannot be recommended for bonding coronary anastomoses.