ABSTRACT 71

END-TO- END STAPLER ANASTOMOSIS IN MIDCABG: A BLIND ALLEY OR A BLIND SPOT?

Evgenii V.Kolesov, St. Peterburg (Russia)-Dnepropetrovsk (Ukraine)

OBJECTIVE. The oldest method of end-to-end anastomosing in the coronary bypass surgery is now generally rejected without serious study or discussion. Such attitude even widespread could be wrong as it happened, e.g., with inattention to IMA as a conduit in the early 1970s.

METHODS. Experimental investigations of end-to-end stapler techniques for IMA-LAD anastomosis on the beating heart were started in StPeterburg in 1965 and in 1967 were carried through to the clinical practice. Serial circular staplers with mechanical and suction assisted evertion of vessel edges were employed. Heart rate modulation or stabilizers were not used.

RESULTS. In the 70-th the clinic accumulated a very positive experience of about 250 consecutive patients the staplers had been used to create end-to-end IMA-LAD  and  SVG-RCA bypasses on the beating heart. One of major advantages of this technique was practically complete avoidance of anastomotic stenoses (regularly seen with continuous monofilament suturing). Despite of nowadays skepticism this approach has strong background for restoring flow in occluded coronary arteries, especially in elderly patients with advanced IHD who need fast and light procedures.

CONCLUSIONS. End-to-end type of coronary anastomoses and corresponding staplers could be introduced for certain patient categories, so highly contributing the concept of MIDCABG.