| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Ann Thorac Surg 2003;75:1434-1436
© 2003 The Society of Thoracic Surgeons
a Clinic for Cardiovascular SurgeryUniversity Hospital, Berne, Switzerland
b Division of Cardiology, University Hospital, Berne, Switzerland
Accepted for publication November 14, 2002.
* Address reprint requests to Dr Carrel, Clinic for Cardiovascular Surgery, University Hospital Berne, CH-3010 Berne, Switzerland.
e-mail: thierry.carrel{at}insel.ch
BACKGROUND: Increasing practice of less-invasive coronary artery bypass surgery has generated a revival of automated methods to facilitate the creation of vascular connections during coronary artery bypass grafting procedures.
METHODS: We have reviewed our clinical experience with 107 patients who received at least one proximal Symmetry aortic connector from St. Jude Medical Anastomotic Technology Group (St. Paul, MN) to connect a saphenous vein graft to the ascending aorta, in whom the minimal follow-up is 6 months. Seventy-five patients were part of an observational study, and 32 patients were enrolled in a prospective randomized study to compare the anastomotic device with the conventional suture technique. Key lessons and pitfalls observed during loading and deployment as well angiographic findings are presented.
RESULTS: Hospital mortality was 0.9% (1/107); a 76-year-old woman suffered from cerebral complications and died after combined coronary artery bypass grafting and aortic valve replacement. Two connectors had to be removed because of leakage and one because of incomplete deployment. The residual 104 grafts connected to the ascending aorta were patent at the end of the operation (mean flow, 72 ± 29 mL/min). Fourteen patients from the prospective study have received 6 months of angiographic assessment so far. Forty-two grafts have been evaluated: all IMA grafts (n = 14) are patent. Four radial artery grafts have been studied: three are patent and one is occluded. Twenty-four vein grafts have been assessed: 11 were hand-sewn and 13 were connected to the aorta with the proximal connector system. Patency rate is not different between the two techniques, but there is an incidence of 38% (5/13) stenosis in the proximal vein graft segment in those patients with a proximal connector. No proximal hand-sewn anastomosis shows any significant stenosis.
CONCLUSIONS: The use of proximal devices allows ultra-fast connection of a bypass graft to the aorta. The handling of this device is simple, manipulations on the ascending aorta are minimized, and hemostasis is perfect. However, because stenoses have been observed in the vein graft close to the connector site, mid- and long-term patency rates have to be assessed in large prospective trials.
This article has been cited by other articles:
|
|
 |
|
  T. Shimokawa, S. Manabe, T. Sawada, S. Matsuyama, T. Fukui, and S. Takanashi Intermediate-term patency of saphenous vein graft with a clampless hand-sewn proximal anastomosis device after off-pump coronary bypass grafting. Ann. Thorac. Surg., May 1, 2009; 87(5): 1416 - 1420. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. F. Buxton, P. A.R. Hayward, A. E. Newcomb, S. Moten, S. Seevanayagam, and I. Gordon Choice of conduits for coronary artery bypass grafting: craft or science? Eur. J. Cardiothorac. Surg., April 1, 2009; 35(4): 658 - 670. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Takemura, Y. Fukumoto, T. Miyauchi, K. Shimabukuro, M. Imaizumi, and N. Ishida Easy Technique for Mounting the Heartstring System into the Sheath Asian Cardiovasc Thorac Ann, October 1, 2007; 15(5): 444 - 445. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Bergmann, K. Meszaros, S. Huber, P. Oberwalder, H. Machler, G. Schaffler, R. Rienmueller, and B. Rigler Forty-one-month follow-up of the Symmetry aortic connector system for proximal venous anastomosis J. Thorac. Cardiovasc. Surg., July 1, 2007; 134(1): 23 - 28. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. G. Kachhy, D. F. Kong, E. Honeycutt, L. K. Shaw, and R. D. Davis Long-Term Outcomes of the Symmetry Vein Graft Anastomosis Device: A Matched Case-Control Analysis Circulation, July 4, 2006; 114(1_suppl): I-425 - I-429. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. S. F. Fischer, B. Phillips-Bute, M. Swaminathan, C. Milano, and M. Stafford-Smith SymmetryTM Aortic Connector Devices and Acute Renal Injury: A Comparison of Renal Dysfunction After Three Different Aortocoronary Bypass Surgery Techniques Anesth. Analg., January 1, 2006; 102(1): 25 - 31. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Skjelland, J. Bergsland, R. Lundblad, P. S. Lingaas, K. A. Rein, S. Halvorsen, J. L. Svennevig, E. Fosse, R. Brucher, and D. Russell Cerebral microembolization during off-pump coronary artery bypass surgery with the Symmetry aortic connector device J. Thorac. Cardiovasc. Surg., December 1, 2005; 130(6): 1581 - 1585. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Setina, A. Krchnakova, A. Mokracek, L. Pesl, and L. F. Bonilla The Second-Generation Aortic Connector: Six Months' Angiographic Follow-Up Ann. Thorac. Surg., August 1, 2005; 80(2): 695 - 699. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. A. Frazier, F. Qureshi, K. M. Read, R. C. Gilkeson, R. S. Poston, and C. S. White Coronary Artery Bypass Grafts: Assessment with Multidetector CT in the Early and Late Postoperative Settings RadioGraphics, July 1, 2005; 25(4): 881 - 896. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Vicol, M. Oberhoffer, G. Nollert, S. Eifert, P. Boekstegers, B. Wintersperger, and B. Reichart First Clinical Experience With the HEARTSTRING, a Device for Proximal Anastomoses in Coronary Surgery Ann. Thorac. Surg., May 1, 2005; 79(5): 1732 - 1737. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Dietrich, S. Martens, M. Kohlert, C. Herzog, M. F. Khan, G. Wimmer-Greinecker, and A. Moritz Decreased intermediate term patency of automated proximal anastomoses evaluated by sequential ultrafast CT Eur. J. Cardiothorac. Surg., April 1, 2005; 27(4): 579 - 583. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. M. Melero, C. Porras, M. Such, E. Olalla, and J. Alonso Severe Stenosis of Anastomoses by Using the Symmetry Aortic Connector System Ann. Thorac. Surg., November 1, 2004; 78(5): 1831 - 1833. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. S. Eckstein Reply Ann. Thorac. Surg., November 1, 2004; 78(5): 1879 - 1879. [Full Text] [PDF]
|
|
|
|
|
|
B. Medalion, D. Meirson, E. Hauptman, L. Sasson, and A. Schachner Initial experience with the Heartstring proximal anastomotic system J. Thorac. Cardiovasc. Surg., August 1, 2004; 128(2): 273 - 277. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Redaelli, F. Maisano, G. Ligorio, E. Cattaneo, F.M. Montevecchi, and O. Alfieri Flow dynamics of the St Jude Medical Symmetry aortic connector vein graft anastomosis do not contribute to the risk of acute thrombosis J. Thorac. Cardiovasc. Surg., July 1, 2004; 128(1): 117 - 123. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Okada, T. Sueda, K. Orihashi, and K. Imai Early type A dissection with the aortic connector device Eur. J. Cardiothorac. Surg., May 1, 2004; 25(5): 902 - 904. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. J. Cavendish, W. F. Penny, M. M. Madani, S. Keramati, O. Ben-Yehuda, D. G. Blanchard, E. Mahmud, A. Perricone, and S. Tsimikas Severe ostial saphenous vein graft disease leading to acute coronary syndromes following proximal aorto-saphenous anastomoses with the symmetry bypass connector device: Is it a suture device or a "stent"? J. Am. Coll. Cardiol., January 7, 2004; 43(1): 133 - 139. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
