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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Friedrich S. Eckstein Thierry P. Carrel Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Eckstein, F. S. Articles by Carrel, T. P. Search for Related Content PubMed Articles by Eckstein, F. S. Articles by Carrel, T. P. Related Collections Minimally invasive surgery

Ann Thorac Surg 2003;75:322-323
© 2003 The Society of Thoracic Surgeons

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Correspondence

Descending aorta–obtuse marginal coronary artery bypass grafting using an automatic anastomotic device: Reply

^a Clinic for Cardiovascular Surgery, University Hospital, Inselspital, Freiburgstrasse, CH-3010 Bern, Switzerland

e-mail: friedrich.eckstein{at}insel.ch

To the Editor:

Drs Frank and Stefanacci decribe their experience with the St. Jude Medical Anastomotic Technology Group Symmetry anastomosis device for proximal vein graft anastomoses at the level of the descending aorta in redo coronary artery bypass grafting. Recently we [1] had comparable favorable results while constructing a proximal anastomosis of the saphenous vein graft in the abdominal aorta for an aortomesenteric bypass procedure in a patient with intestinal ischemia. Even if these are very promising approaches, we would like to recommend that angiographic follow–up will be mandatory to prove similar or better graft patency rates compared with sutured anastomoses.

Care must be taken when using this device in the descending or abdominal aorta where severe atherosclerotic disease is more likely than in the ascending aorta. Proper location of the proximal anastomosis avoids embolism of aortic debris by coring the aortic hole. Therefore, we recommend epiaortic scanning to facilitate adequate the choice of the anastomosis site and to minimize the risk of embolization or failure. This is even more important when choosing a location where side-biting the aorta is difficult or impossible. Care should also be taken with planned delivery of the device in a vessel with an inner luminal diameter of less than approximately 2 cm. This is the minimum required diameter for reliable delivery and placement of the device.

In conclusion, the St. Jude Medical Anastomotic Technology Group Symmetry aortic connector for proximal vein graft anastomoses and other mechanical vascular connecting devices offer new ways for cardiac and vascular surgeons to reduce operative trauma, risk, and time. In addition, such tools may be an excellent option for performing anastomoses in unusual places.

References

1. Schmidli J, Heller G, Englberger L, Eckstein FS, Carrel TP. First clinical experience with an anastomotic device to facilitate aortomesenteric saphenous vein bypass. J Vasc Surg (in press)

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Friedrich S. Eckstein Thierry P. Carrel Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Eckstein, F. S. Articles by Carrel, T. P. Search for Related Content PubMed Articles by Eckstein, F. S. Articles by Carrel, T. P. Related Collections Minimally invasive surgery