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(Circulation. 2006;114:I-390 – I-395.)
© 2006 American Heart Association, Inc.

Surgery for Coronary Artery Disease

S² Connector Versus Suture

Distal Coronary Anastomosis Remodeling, Patency, and Function in the Pig

Willem J.L. Suyker, MD; John P. Matonick, PhD; Paul T.W. Suyker, MSc, MBA; Aart Brutel de la Rivière, MD, PhD; Marc P. Buijsrogge, MD, PhD; Ricardo P.J. Budde, PhD; Cees W.J. Verlaan; Gerard Pasterkamp, MD, PhD; Paul F. Gründeman, MD, PhD; Cornelius Borst, MD, PhD

From Isala Klinieken (W.J.L.S.), Zwolle, the Netherlands; iiTech BV (W.J.L.S., P.T.W.S.), Amsterdam, the Netherlands; Ethicon Inc (J.P.M.), Somerville, NJ; Onze Lieve Vrouwen Gasthuis (A.B.d.l.R.), Amsterdam, the Netherlands; Academic Medical Center (M.P.B.), Amsterdam, the Netherlands; Heart Lung Center (R.P.J.B., C.W.J.V., G.P., P.F.G., C.B.), Utrecht University Medical Center, Utrecht, the Netherlands.

Correspondence to Willem J. L. Suyker, MD, Cardiothoracic Surgeon, Isala Klinieken (Location: Weezenlanden, Groot Wezenland 20), P.O. Box 10500, 8000 GM Zwolle, the Netherlands. E-mail w.suyker{at}isala.nl

Background— Anastomotic connectors could be the key to less invasive bypass surgery, including endoscopic procedures, but equivalence to conventional suturing needs to be established. A novel distal coronary connector was tested pre-clinically for safety and efficacy in comparison to conventional suturing.

Methods and Results— Left internal thoracic to left anterior descending coronary artery bypasses were constructed off-pump in 35 pigs (73±8 kg). An intraluminal metal connector (S²AS) was used in 21 and conventional suturing in 14 animals. S²AS anastomosis construction was easier achieved in one-fourth of the conventional construction time (3.7±0.7 versus 16.5±2.6 minutes; P<0.001). Acute patency tended to be better (P=0.15). All anastomoses were evaluated intraoperatively, and subgroups at 90 and at 180 days. Patency was 100%. An effective remodeling response was observed in all groups, resulting in unobstructed anastomoses with excellent hemodynamic performance (fractional flow reserve 0.93 at 180 days). At 6 months, the noncompliant connector was covered with stabilized neointima that was thinner than found on the suture line (0.10±0.04 versus 0.31±0.13 mm; P=0.01). The connector induced less lumen loss (–0.6±6.5 versus 21.6±19%; P=0.03). The initial side-to-side configuration had remodeled to an end-to-side shape as intended.

Conclusions— In the porcine model, the connector rapidly and consistently produced high-quality anastomoses that fully met current standards on patency and function. Unconventional aspects like a noncompliant intraluminal ring and a side-to-side to end-to-side converted configuration did not interfere with favorable anastomosis remodeling. These findings shed a new light on the anatomical prerequisites for anastomosis patency.

Key Words: anastomosis • bypass • connector • hemodynamic • remodeling • surgery