A lot has been written on the merits and shortcomings of a variety of methods of vessel occlusion during beating heart CABG. The most notable methods use suture snares, silicone tapes, silicone tubes, pledgets with tapes or sutures, shunts, and CO2 blowers with and without humidifying mist. The common theme seems to point towards not touching endothelium or pinching the artery too harshly in order to preserve its function.
CORONEO has arrived at a clever and simple solution that can help you suture distal anastomoses in a clear bloodless field while minimizing trauma to the coronary artery's endothelium.
Perrault, Menasché, et al have shown that endothelial dysfunction can occur as a result of the use of gas jet insufflation or bulldog clamps on coronary arteries. Further study by Perrault et al has shown that the use of shunts, silicone tape, or bulldog clamps have an effect on the serotonin relaxation of arteries similar to denuding them of their endothelium with a balloon catheter.
Another study by Burfeind, Duhaylongsod, et al found that high flow CO2 gas insufflation denudes arteries of endothelium when compared to an arteriotomy simply exposed to ambient air. Okazaki, Takarabe, et al found that silicone elastic loop snaring was less traumatic to the endothelium when compared to suture snaring and CO2 gas insufflation with and without humidifying.
Studies seem to indicate that the least traumatic method of ensuring a bloodless field at the location of the distal anastomosis is to use a silicone elastomer tape when when the heart muscle distal to the arteriotomy is deemed to be able to tolerate momentary reduction in blood supply. The CORONEO Swift Loop with Pledget is designed specifically for use on coronary arteries, and is deployed by itself to occlude the target artery without having to anchor the free ends of the vessel loop to a surgical platform, or a motionless portion of the patient's anatomy. When used with CORONEO's COR-VASC System, the vessel loop can be easily anchored to the cleats provided on the coronary stabilizer to further stabilize the target artery within the stabilizer.
The CORONEO Swift Loop is available with and without an elastomeric pledget. A special model with shorter length silicone elastomer loop with pledget is also available for use with the Intuitive Surgical Robot.
But why would I need a pledget on my silicone elastomer loops?
However atraumatic the silicone elastomer loop may be, using it like a snare will tend to give an artery a radial compression. The artery will be able to take only a limited amount of radial deformation after which it will buckle at multiple locations and fold up into a star shape and thus cause multiple lesions along the circumference of the endothelium. Using a pledgetted vessel loop will reduce the number of lesions to two since the artery can be flattened instead of radially strangled.
Now comes the most interesting part. The elastomeric pledget, apart from being soft and flexible, is designed like a clip that can be opened by squeezing the blue elastomer and clamped onto the silicone elastomer loop without adding to the artery's distress. The pledget can then be removed just as easily by squeezing the blue elastomer to release it from the silicone loop...no additional tension on the artery is applied.
The CORONEO Swift Loop is available in boxes of 10 sterile pouches with two units per pouch, except for the version designed for the Intuitive Surgical Robot which has one unit per pouch. Order the CORONEO Swift Loops by asking your favorite medical supplier for the following product codes:
1010643 - Swift Loop 12", box of 20 (10 x 2 sterile units)
1010815 - Swift Loop 6" with Pledget, box of 20 (10 x 2 sterile units)
1011058 - Swift Loop 3" with Pledget, box of 10 sterile units.