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Ann Thorac Surg 2006;82:1456-1457
© 2006 The Society of Thoracic Surgeons

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Original Articles: Cardiovascular

Invited commentary

Division of Cardiothoracic Surgery, University of Cincinnati, 231 Albert B Sabin Way, Mail Location 558, Cincinnati, OH 45267-0558

(Email: randall.wolf{at}uc.edu).

Clinically reliable and surgeon acceptable distal anastomotic devices (DAD) for coronary bypass procedures have been the dream of innovative surgeons and engineers and the focus of enterprising medical device companies for the last decade. Realizing this dream has been, as the old saying goes, "1% inspiration and 99% perspiration." Many ideas, some companies, and a great deal of capital have littered the automated anastomotic road leading to reliable DADs. Are we finally visualizing the products that would make Alexis Carrel proud?

The article by Vicol and colleagues [1] is important because they have demonstrated noninferiority of the coupler compared with hand-sewn anastomoses. There were no deaths, no myocardial infarctions, no recurrent angina pectoris, and no reinterventions. In other words, the magnetic DADs studied were safe.

Although all procedures in the current study were performed while the patients were on cardiopulmonary bypass, when I was on sabbatical in Leipzig a few years ago, I had the opportunity to implant some of the magnetic couplers off-pump and found them to simplify beating-heart surgery.

We should view this report as an important step in the DAD dream. Although there have been disappointing results with one proximal anastomotic device, this article reminds us that some automatic devices will work, others will not. This is a process, and it is encouraging to see a well-documented report of a safe DAD.

There are still hurdles in the road, including the high initial cost of DADs, and in the current article for the first time, clinical evidence that magnetic resonance imaging can affect the magnetic coupler. But as technology continues to drastically alter the tools of the trade of the cardiac surgeon, it appears we may be at the end of the beginning of safe automatic devices for coronary surgery. Hopefully, Alexis Carrel would be proud.

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1. Vicol C, Eifert S, Oberhoffer M, Boekstegers P, Reichart B. Mid-term patency after magnetic coupling for distal bypass anastomosis in coronary surgery Ann Thorac Surg 2006;82:1452-1457.[Abstract/Free Full Text]

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 Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Randall Kevin Wolf Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Wolf, R. K. Search for Related Content PubMed PubMed Citation Articles by Wolf, R. K. Related Collections Coronary disease Related Article