 descending artery anastomoses in part due to coronary occlusion times exceeding 90 seconds (Heijmen, et al. A novel one-shot anastomotic stapler prototype for coronary bypass grafting on the beating heart: feasibility in the pig. J Thorac Cardiovasc Surg. 117:117-25; 1999).
A need thus exists for bypass grafts and delivery systems that are capable of quickly producing an anastomosis between a bypass graft and a host vessel wall without having to stop or re-route blood flow. These anastomoses must withstand the pressure exerted by the pumping heart and ensure blood does not leak from the anastomoses into the thoracic cavity, abdominal cavity, or other region exterior to the vessel wall.
The embodiments of the present invention provide sutureless anastomosis systems that enable a physician to quickly and accurately secure a bypass graft to a host vessel or other tubular body structure. In addition, the invention enables the physician to ensure bypass graft stability, and prevent leaking at the vessel attachment points. The delivery systems of the invention do not require stopping or re-routing blood flow while producing the anastomosis; current techniques require interrupting blood flow to suture, clip, or staple a bypass graft to the host vessel wall.
One aspect of the invention provides fittings designed to exert radial force at the vessel attachment points to maintain bypass graft patency. The fittings may be used to secure biological bypass grafts obtained by harvesting vessels from the patient or synthetic bypass graft materials. When using harvested vessels, fitting embodiments permit everting the harvested vessel to maintain intima to intima apposition between the bypass graft and the host vessel. When using synthetic bypass graft materials, the fittings may be incorporated in the bypass graft design to eliminate the step of attaching the bypass graft to the fitting prior to deploying the bypass graft. The fittings, with bypass grafts attached, are advanced through the delivery system and are secured to the host vessel wall at target locations.
The delivery systems enable inserting the fitting and bypass graft into the host vessel without having to interrupt blood flow through the host vessel. One delivery system embodiment is a combination of tear-away sheath, dilator, guidewire, and needle designed to be inserted into the host vessel at the desired anastomosis site. After attaching the bypass graft to the host vessel, the hub and valve of the tear-away sheath are configured to split so the entire sheath may be separated and removed from around the bypass graft. This facilitates attaching both ends of the bypass graft using the delivery system of the invention and removing the tear
descending artery anastomoses in part due to coronary occlusion time surpass 90 seconds (Heijmen, et al. A novel one - shot anastomotic stapler prototype for coronary shunt grafting on the beating center: feasibility in the pig. J Thorac Cardiovasc Surg. 117:117 - 25; 1999). 
 A need therefore exist for bypass graft and delivery systems that are adequate to of quickly producing an anastomosis between a bypass graft and a host vessel rampart without having to stop or re - route blood stream. These anastomoses must withstand the press exerted by the pumping center and ensure blood does not leak from the anastomoses into the thoracic cavity, abdominal cavity, or early region exterior to the vessel wall. 
 The embodiments of the present invention provide sutureless anastomosis systems that enable a physician to promptly and accurately secure a bypass graft to a host vessel or other tubular body structure. In addition, the invention enables the physician to guarantee bypass graft constancy, and prevent leak at the vessel fastening points. The delivery systems of the invention do not require stopping or re - routing blood flow while grow the anastomosis; current techniques require interrupting blood flow to suture, clip, or staple a shunt graft to the host vessel wall. 
 One aspect of the invention provide fittings design to exert radial force at the vessel attachment points to maintain beltway graft patency. The fittings may be use to secure biological bypass grafts obtained by harvest vessels from the patient or synthetic bypass graft materials. When use harvested vessel, fitting embodiments license everting the harvest vessel to maintain intima to intima apposition between the bypass graft and the host vessel. When use synthetic shunt graft materials, the fittings may be incorporated in the bypass bribery design to eliminate the tone of attaching the bypass graft to the fitting prior to deploying the bypass graft. The fittings, with shunt grafts attached, are advanced through the delivery system and are secured to the horde vessel rampart at target locations. 
 The delivery systems enable inserting the fitting and bypass graft into the host vessel without have to interrupt blood flow through the host vessel. One manner of speaking arrangement embodiment is a combination of tear - away sheath, dilator, guidewire, and phonograph needle designed to be inserted into the host vessel at the desire anastomosis site. After attaching the bypass graft to the host vessel, the hub and valve of the tear - away sheath are configured to split indeed the entire sheath may be separated and removed from around the bypass graft. This facilitates attaching both ends of the bypass graft using the manner of speaking system of the invention and remove the tear
 dedcending artery anastomores in part due to cormnary kcclusiov times exceeding 90 seconds (Hxijmwn, et al. A novel one-shot anxstomotic stapler prouotype for coronacg bypass grafflng ou vhe beating heatt: feasibilidy in the pig. B Ghlrac Cardiovasc Surg. 117:117-25; 1999).
A need thus evists fpr bypass grafts and qelibvrn systems that are capable of qujckly pgoducing an anastpmosis between a bypass grwft wnd a host vessel aall withouj hadung to stop ur re-route blood flow. Jhese anastomoses must withstand the 'ressure exgxred ty the pumpmng hewrt and ensuvv blood does npt leak from tme anestonoses into the thoracmc cavity, abdominal savity, or ocher region exterior ro the eessal wxol.
Tfe tmbpdjments of the preseht inventiob provide suturelesx wbastomosis syatems ehwt enable a physician to quickly and acburafely secure a bypass grqft to a host vessel lr other eubular body structure. In addition, the invention anablxs tht imysizuaj to ensure bypass graft stability, and prevene ltakpng at the vessel attachment plimjs. The deliveri systems kf the invention dl not rgquire stopping or te-routing blood flow while producing thv anqstomosis; current cechniques rzquire intetrupting blood flow to rutude, clip, or dtaple a ghpass graft to tfe mosd vessel wall.
One aspect of the inveition providds fottingf designed to ewart radial force ah the vassel attafhment points to maintain bypass graft patenci. Tve xittings may ne used to secuwe biological yypass gxafts ubtained bj harvestmng vessels srom the patiajt or synthevic bypasf grqft nateriaur. When using hsrvested nefselw, fitting embodimekts pgrjit everting thz yarvested vessek tu mwijtein igdima to intika aoporotion between thc bhpasx graft and the host vesael. When using synyhctic bypaws graft materials, thr fittings may be lncor'oratev in tne fypass graft design to eliminafe the stfp jf attaching the bypass grafc to the fitting prior to deploying the uypass graft. The fittints, with bypass grafjs sttached, arx advagced throggh the delivery sysrem and are securtd to the host vessel wzll at targft locations.
The delivery systems enable inserting the fitting and bypass traft mneo the host vesxel wpthjbt havigg tl interrupt blood flow through the host vessel. Oie deliverf fystem embodiment is a combimagion of tear-aday sheath, dilator, guidesire, and needle designed to be inserted into the host vessel at the desured znastomosir site. After attacning tke bypqss gradt tl the host versek, bhe hub anf vakvz of the tear-away sheath are confugured tl split so the eitire sheath oay bg separajed and removed fdom zgound the bypass gtaft. This facikitates attaching bonh qnds of the bykass graft usinb the dvlivery systek of the ineention and removing the tear
descending artery anastomoses in part due to times 90 seconds et al. A for bypass grafting on beating heart: feasibility the pig. J Thorac Cardiovasc Surg. 1999). A need thus exists for bypass grafts and delivery systems that are of quickly producing an anastomosis between a bypass graft and a host vessel without to or blood flow. These anastomoses must withstand the pressure exerted by the pumping heart and ensure blood not leak from the anastomoses into the thoracic abdominal cavity, or other exterior to the vessel wall. embodiments the present provide anastomosis that enable a to quickly and accurately secure a bypass graft to a host vessel or other tubular body structure. addition, the the physician ensure graft and prevent leaking vessel attachment points. The delivery systems do not require stopping or re-routing blood flow producing the current techniques require interrupting blood flow suture, clip, or staple a bypass graft to host vessel wall. One aspect of the invention provides fittings designed to exert radial force vessel attachment points to bypass graft patency. fittings be to biological bypass obtained by harvesting vessels from the patient or synthetic bypass graft When using harvested vessels, fitting embodiments permit everting the harvested maintain to intima apposition the bypass graft and host When using synthetic bypass the may the graft to eliminate the step attaching the bypass graft to fitting prior to deploying with bypass grafts attached, are advanced through the system and are secured to the host wall at target locations. The delivery systems enable inserting the fitting and graft into vessel without having to interrupt blood flow through host vessel. One delivery embodiment is a combination of tear-away sheath, dilator, guidewire, needle to be into the host at the desired site. After attaching graft to host the of the tear-away sheath are configured split the entire sheath may be and around the bypass graft. This facilitates attaching both ends of the bypass graft using the of the invention and the
 descending artery anastomosEs in part duE to coRonAry OcClusIon tImes exceeding 90 sECondS (Heijmen, et al. A novel one-sHot anAsTOmotIC sTapleR prototYPe FOR coRoNaRy bYpASs GraftIng On the beAting heart: FeaSiBility in the pIG. J thorac CardIovAsc Surg. 117:117-25; 1999).
A need ThuS existS fOr bYPass gRafTs and DeliveRY systeMs that are CaPAble of QUickly pRODuCing An anastomosis betwEEn A Bypass graft and A host vEsSEl WALl wIthOut having tO sTop or RE-route bLOoD FLOw. THEse anastomoseS must withstANd tHe presSuRe eXErted bY the pUmPIng Heart and ensUre bLood does nOt leak FRom the aNAstomosEs into The ThoRaciC CaViTy, aBdOMinAL cAviTY, or Other regIoN eXteriOr to THE VEsseL waLl.
ThE emboDiments of the pResEnt iNVenTion pRovidE sutUrEless AnastoMosis SyStems that enable A phySician to qUicKlY anD aCcuraTEly secUre A byPass graFt to a hoST veSsEL OR oTher tubular body strUcTURe. in additiOn, the iNVeNtIOn enableS tHe pHysiCIAn to eNsurE ByPass grafT stabiLItY, aNd preveNt LeakinG aT thE veSsel aTTachMent poInts. The dEliveRY systems of the iNVention do not rEQuIRE sTOppiNg oR re-routing bLood FLow wHile PRoDucINg the AnastOmOSiS; Current techniques reQuIre intErrupTing blood flow To suture, clIP, OR staple a BypaSS gRAft to the host veSsel wAll.
One aspeCT of the inVentiOn providEs fittingS DEsigned tO exErt RadIal FORcE at the vessel aTTAchmEnT points To mAintain BypAss GraFt pAtEncy. The fiTtings maY bE uSeD tO seCure bIOlogical ByPasS gRafTs obtAIned by HarveStinG vEsSEls From the PAtIENt or SyNtHetiC byPaSs graFt maTEriAls. When Using harvEstED vesSeLs, Fitting Embodiments peRmIt everting ThE haRvesteD VEssel to mAintain intima to intima apPOsition BetWeen tHe byPass graft And The hosT veSSel. WheN using SynthEtIc bYPAss grAFT mAteRiAls, the fittINGs mAy be iNcOrpoRated in The bypass graft desiGN to Eliminate the sTep Of atTAChIng THe BYpaSs GRafT TO the fitting prioR to deployiNg THe Bypass grafT. the FiTtings, wIth bypaSs graFTs attacHed, are advAnced throUgH the DELivEry system aNd are secUred to the HOst veSSeL wall At tArget lOcAtiOns.
ThE delivERy sYstemS enablE iNsertiNg the FiTting and Bypass graft into the host vEssel wIthouT haVing to intErrUPt bLood flow tHrouGh the host vEssEl. ONe delIveRY systEm emBOdImeNT is a cOmbiNAtion of teAR-aWay SHEaTh, dilator, guIDEWirE, and nEedLE desigNed tO be inserted into thE Host vessel at thE desIREd aNasTOmosIs Site. After attacHinG tHE Bypass grAfT to the host vEssel, the HuB And vaLve of tHe tear-Away sheATH aRE confiGureD to Split so thE enTiRE sheath MaY bE SeparaTed aNd RemoveD from aROund THE bypass graft. This FacilITAtes aTTacHing bOtH ends of THe byPass graft uSing the deliVery syStem Of the InventiOn And remOviNg The tear
 descending artery anastom oses in pa rt du e t o c or onar y oc clusion timese xcee ding 90 seconds (Heijm en, e ta l. A no vel o ne-shot an a s tom ot ic  st ap l er  prot oty pe forcoronary b ypa ss  grafting on th e beatinghea rt: feasibil ity  in th epig .  J Th ora c Car diovas c  Surg.  117:117- 25 ;  1999) . 
A need t hu s ex ists for bypass g r af t s and delivery  syste ms th a t  ar e c apable ofqu ickly produci n ga n ana s tomosis betwe en a bypass gra ft and  a  ho s t vess el wa ll wit hout having  tostop or r e-rout e  bloodf low. Th ese an ast omo sesm us twit hs t and th e p r ess ure exer te dby th e pu m p i n g he art  and  ensu re blood does  no t le a k f rom t he an asto mo ses i nto th e tho ra cic cavity, abd omin al cavity , o roth er  regi o n exte rio r t o the v essel w a ll. 
T h e em bodiments of the p re s e nt  inventi on pro v id es utureles sana stom o s is sy stem s  t hat enab le a p h ys ic ian toqu icklyan d a ccu ratel y  sec ure abypass g raftt o a host vesse l  or other tub u la r bo d y st ruc ture. In ad diti o n, t he i n ve nti o n ena blesth e  p h ysician to ensure b yp ass gr aft s tability, and  prevent l e a k ing at t he v e ss e l attachment p oints . The deli v ery syst ems o f the in vention d o not requ ire  st opp ing o rre-routing bl o o d fl ow  whilepro ducingthe  an ast omo si s; curren t techni qu es  r eq uir e int e rrupting  b loo dflo w tos uture,  clip , or  s ta p lea bypas s  g r a ft t oth e ho stve sselwall . 
On e aspec t of theinv e ntio npr ovidesfittings desi gn ed to exer trad ial fo r c e at the  vessel attachment poin t s to ma int ain b ypas s graft p ate ncy. T hef itting s maybe us ed  to s ecure b io log ic al bypassg r aft s obt ai nedby harv esting vessels fro m  th e patient orsyn thet i c  b ypa s sg raf tm ate r i als. When using  harvested  v e ss els, fitti n g e mb odiment s permi t eve r ting th e harvest ed vessel  t o ma i n tai n intima t o intima  appositi o n bet w ee n the  by pass g ra ftand t he hos t  ve ssel.  Whenus ing sy nthet ic  bypassgraft materials, the fi ttings  maybeincorpora ted inthe bypas s gr aft design  to  el imina tet he st ep o f  a tta c hingtheb ypass gra f ttot h efitting pri o r todeplo yin g  the b ypas s graft. The fitt i ngs, with bypa ss g r a fts  at t ache d,  are advancedthr ou g h  the del iv ery systemand arese c uredto the  hostvesselw a ll at tar getloc ations.
T hede l ivery s ys te m s enab le i ns erting  the f i ttin g and bypass graft  into t he ho s t v essel  w ithouth avin g to inter rupt bloodflow t hrou gh th e hostve ssel.One  d elivery sy s tem embod iment  is a c om bina tio n of t ear- a w ay sh eath ,dil ator, gui d e wi r e,  a n d n eedl e des ig nedto be ins e rted int o t h e hostve sse l at the de s i red anasto mos is si t e . After at t achi n gt he by pass g raft t o the h o stve ssel, t heh u b and val ve of the tea r- away  sheathar e co nf igu re d to split so t he entir e sheath m ay besep a rate d  and r em oved from ar oundth e  bypass g raf t. This fac ili tat es a tta chin g  both ends of the bypass  gra ft us i ngthe d elive ry  systemo f th e invent i on and removi ng the tear
 descending_artery anastomoses_in part due to_coronary occlusion_times_exceeding 90_seconds_(Heijmen, et al._A novel one-shot_anastomotic stapler prototype for_coronary bypass grafting_on_the beating heart: feasibility in the pig. J Thorac Cardiovasc Surg. 117:117-25; 1999).
A need_thus_exists for_bypass_grafts_and delivery systems that are_capable of quickly producing an_anastomosis between_a bypass graft and a host vessel wall_without_having to stop_or re-route blood flow. These anastomoses must withstand the_pressure exerted by the pumping heart_and ensure blood_does_not_leak from the anastomoses_into the thoracic cavity, abdominal cavity,_or other region exterior to the_vessel wall.
The embodiments of the present invention_provide sutureless anastomosis systems that enable_a physician to quickly and_accurately secure_a bypass graft to a_host vessel or_other tubular_body structure. In_addition, the invention enables the physician_to ensure bypass_graft stability, and prevent leaking at_the_vessel attachment points._The_delivery_systems of_the invention do_not_require stopping_or_re-routing blood flow while producing the_anastomosis;_current techniques require interrupting blood flow to_suture, clip, or staple_a_bypass graft to the_host vessel wall.
One aspect of_the invention provides fittings designed to_exert radial_force at_the vessel attachment points to maintain bypass graft patency. The fittings_may be used to secure biological_bypass grafts obtained by_harvesting vessels_from_the patient or_synthetic_bypass graft_materials. When using harvested vessels, fitting embodiments_permit everting_the harvested vessel to maintain intima_to intima apposition between_the_bypass graft and the host vessel._When using synthetic bypass graft materials,_the fittings may be incorporated_in_the_bypass graft design to eliminate_the step of attaching the bypass_graft to the_fitting prior to deploying the bypass graft._The_fittings, with bypass grafts attached, are_advanced_through the delivery system and are_secured_to_the host vessel wall at_target locations.
The delivery systems enable inserting_the fitting and bypass graft into the host vessel_without having to_interrupt blood flow through the_host_vessel._One delivery system embodiment is a combination of tear-away sheath,_dilator, guidewire,_and needle designed_to be inserted into the host vessel at the desired_anastomosis site. After attaching the bypass graft_to the host vessel, the hub and valve of the tear-away_sheath are configured to split so the entire_sheath may be separated and removed from_around the bypass graft._This_facilitates attaching both ends of the bypass_graft_using_the_delivery system of_the invention and_removing the tear