Summary:
Researchers from the Cardiopulmonary Research and Science Technology Institute, Medical City Dallas Hospital, Dallas, Texas have reported on their experience with the Symmetry Bypass System Aortic Connector (St Jude Medical, Inc). This device is used for the construction of sutureless proximal anastomoses of coronary vein grafts to the aorta without the need for aortic clamping.
In a 2-month period from May to July 2001, a total of 139 consecutive proximal anastomoses were performed in 67 patients using the connector. All procedures were performed on a beating heart without cardiopulmonary bypass or aortic clamping maneuvers.
The study's lead author, Dr. Michael Mack states that "intraoperative variables and postoperative results were prospectively collected and retrospectively analyzed" for this study.
Almost all of the consecutive proximal anastomoses, 138/139 (99.3%) were successfully completed with the device with one anastomosis requiring suture revision because of misdeployment.
Six anastomoses (4.3%) required an additional suture for leak. Predeployment problems included "connector loading/preparation malfunction" in 10 grafts (7.2%), five because of "human error" and five "technical failure".
According to the article published in the Annals of Thoracic Surgery, a leading journal in the specialty of cardiothoracic surgery, "at a mean follow-up of 7 months, survival was 94.1% and survival free of major adverse cardiac and cerebrovascular events was 88.1%."
This "initial clinical experience" with the proximal aortic connector "demonstrates safety, reliability, and ease of use" according to Dr. Mack. The authors are involved in randomized studies to determine the benefits of this device over traditional hand sewn techniques using aortic clamping, a procedure which has an associated risk of stroke.
Editor's Note
All devices and techniques are associated with development of stroke. Off-pump techniques have reduced the incidence of stroke significantly. Aortic connectors have a learning curve and cannot be used, in their current forms, to construct anastomoses with arterial conduits.
