Ann Thorac Surg 2006;82:307
© 2006 The Society of Thoracic Surgeons
New technology
Invited commentary
Antonio Maria Calafiore, MD
Division of Cardiac Surgery, University of Catania, Italy, San Camillo de'Lellis Hospital, Via C. Forlanini 50, 66100 Chieti, Italy
(Email: calafiore{at}unich.it).
During the recent years one of the main goals of coronary surgery was to reach a less invasive surgical technique to decrease surgical time, to increase the reproducibility of the anastomosis (proximal or distal), and to obtain a high-quality anastomosis, independently from the skill of the surgeon. The development of automatic connectors, both for proximal and distal coronary anastomoses, followed these concepts and was the consequence of the renewed interest in off-pump coronary surgery. The possibility to use automatic connectors during endoscopic myocardial revascularization was a secondary, but crucial, consequence of the efforts to avoid any major or minor chest incision for coronary surgery.
After more or less 10 years, off-pump coronary surgery became a well-established procedure, but did not overwhelm on-pump surgery. On the contrary, off-pump found its indications and is accepted as one of the techniques for coronary revascularization, with an incidence in the western world of apprximately 20% to 25%. Totally endoscopic coronary surgery remained a niche surgery, and for different reasons (eg, the main reasons being the heavy costs and limitations of software) its diffusion is limited to dedicated centers. The interest in automatic connectors (for distal or proximal anastomoses) is not as huge today as in the previous years, mainly for the costs, and in particular for the proximal devices for the unexpected high incidence of complications, mainly occlusions. Furthermore, we learned that when the ascending aorta is severely diseased, the use of automatic connectors is as risky as the conventional technique. In general, this high technology is marking time, waiting for something really new.
The device described by the authors [1] shows some positive aspect, mainly the lack of any contact between foreign materials and the aortic or venous intima. Perhaps this will not completely solve the problem, but it is the basis for future developments.
Very likely the future of automatic connectors will always be limited by the high cost of the devices, but our efforts to improve this technology have to go on, as the science has to investigate independently from the practical application of its results.
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References
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- Liu L, Liu J, Zhu M, Hu S. Experimental study of one-shot vascular anastomostic device for proximal vein graft anastomoses Ann Thorac Surg 2006;82:303-307.[Abstract/Free Full Text]
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