Catheter-Based Endoscopic Bypass Grafting: An Experimental Feasibility Study

Purpose Construction of an endoscopic catheter-guided, bonded anastomosis to facilitate total endoscopic coronary artery bypass. Description Total endoscopic coronary artery bypass of the left internal thoracic artery to the left anterior descending coronary artery was performed on the beating heart in six pigs using a telemanipulation system. An angioplasty catheter was advanced through the left internal thoracic artery to stabilize the anastomotic site. The anastomosis was created by applying glue externally to the surrounding tissue of the left internal thoracic artery and the left anterior descending coronary artery while it was kept open by an inflated angioplasty catheter. Evaluation Angiography and catheter placement at the graft site was performed in 12 minutes (10 to 28 minutes). The anastomotic constructions were easily accomplished in 3.5 minutes (2 to 4.5 minutes). The adverse events that were encountered were anastomotic leakage requiring additional glue and left anterior descending artery dissection due to the guidewire. All except one animal with an open graft and anastomosis survived the procedure. Patency was 5 of 6. Conclusions Catheter-based endoscopic bypass grafting is feasible. The combination of robotic technology and this simple technique for anastomotic construction may facilitate beating heart total endoscopic coronary artery bypass.