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Fujii T, Watanabe Y, Shiono N, Ozawa T, Hamada S, Masuhara H, Teramoto C, Hara M, Koyama N. Study of coronary artery bypass using the PAS-Port device: assessment by multidetector computed tomography. Gen Thorac Cardiovasc Surg 2009; 57:79-86. [PMID: 19214448 DOI: 10.1007/s11748-008-0334-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2008] [Accepted: 09/12/2008] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The use of automatic anastomotic devices in coronary artery bypass grafting surgery is associated with lower patency rates in comparison to conventional anastomosis methods. This is thought to be caused by graft curvature occurring after closing of the chest wall. METHODS We evaluated 39 grafts in 28 patients who underwent off-pump coronary artery bypass surgery using the PAS-Port. After surgery, the proximal anastomotic angle of each stent, graft morphology, and patency were evaluated with axial and sagittal views. RESULTS The angle for the left anterior descending coronary artery segment was relatively obtuse on the left side of the ascending aorta, and the graft loop formation was not necessary. The angle for the left circumflex coronary artery segment was significantly acute for anastomosis from the upper left side of the ascending aorta. Because grafts are under the constraints of a large loop, graft length tended to become easily excessive or deficient. The angle for the right coronary artery segment was relatively obtuse. The space on the right side of the heart was so narrow that in some cases we had difficulty setting out the appropriate graft location to prevent graft curvature. No bending or stenosis was present in any graft, showing a patency rate of 100%. CONCLUSION The short-term results of coronary bypass grafting using PAS-Port are satisfactory.
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Affiliation(s)
- Takeshiro Fujii
- Division of Cardiovascular Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Toho University, 6-11-1 Omorinishi, Ota-ku, Tokyo 143-8541, Japan.
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2
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Takemura H, Fukumoto Y, Miyauchi T, Shimabukuro K, Imaizumi M, Ishida N. Easy technique for mounting the Heartstring system into the sheath. Asian Cardiovasc Thorac Ann 2007; 15:444-5. [PMID: 17911078 DOI: 10.1177/021849230701500519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The Heartstring system was developed to avoid the use of side-biting aortic clamps, but the sealing system sometimes tears. To solve this problem, a string is wound around the coiled seal and pulled gently.
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Affiliation(s)
- Hirofumi Takemura
- Department of General and Cardiothoracic Surgery, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan.
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3
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Bergmann P, Meszaros K, Huber S, Oberwalder P, Mächler H, Schaffler G, Rienmueller R, Rigler B. Forty-one-month follow-up of the Symmetry aortic connector system for proximal venous anastomosis. J Thorac Cardiovasc Surg 2007; 134:23-8. [PMID: 17599482 DOI: 10.1016/j.jtcvs.2007.02.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2006] [Revised: 02/02/2007] [Accepted: 02/07/2007] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Results of short- and midterm follow-up studies of the patency rate of the Symmetry aortic connector systems (St Jude Medical, Inc, Minneapolis, Minn) are controversial. Long-term follow-up studies are still lacking (so far, the longest mean follow-up period was 19 months). The aim of our study was (1) to evaluate the patency rate of this device over a longer time-period and (2) to analyze risk factors for graft occlusion. METHODS Between November 2000 and July 2003, 76 Symmetry aortic connector systems were implanted in 42 patients. At follow-up, 24 patients with 44 mechanical connectors were studied with 64-slice cardiac computed tomography. Eight patients had died previously, 6 patients refused to undergo a computed tomographic scan, and 4 patients had to be excluded because of impaired renal function. RESULTS From a total of 44 mechanical connectors studied, 24 (55%) were occluded, 20 (45%; confidence intervals 31%-61%) were patent, and 7 of these grafts showed stenosis in the area of the connector. Mean follow-up was 41 +/- 10 months (18-52 months). Sex, age, left main stenosis, hyperlipidemia, hypertension, renal failure, target vessel, stenosis of the target vessel, diameter of the target vessel, type of surgical intervention, diabetes, ejection fraction, postoperative anticoagulation regimen, and the connector size showed no significant influence on the bypass graft patency (P > .05). The bypass graft flow was recognized to be the only risk factor for bypass graft occlusion (P = .0256). CONCLUSION Midterm follow-up data show a high number of occluded Symmetry aortic connector system vein grafts. On the basis of these observations, the use of the connector was abandoned at our institution.
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MESH Headings
- Aged
- Aged, 80 and over
- Anastomosis, Surgical/adverse effects
- Aorta/diagnostic imaging
- Aorta/surgery
- Aortic Valve/diagnostic imaging
- Aortic Valve/surgery
- Aortography
- Blood Vessel Prosthesis/adverse effects
- Calcinosis/surgery
- Cardiovascular Surgical Procedures/adverse effects
- Cause of Death
- Coronary Artery Bypass/instrumentation
- Coronary Artery Bypass/methods
- Coronary Artery Bypass/mortality
- Echocardiography, Transesophageal
- Female
- Follow-Up Studies
- Graft Occlusion, Vascular/diagnostic imaging
- Graft Occlusion, Vascular/etiology
- Graft Occlusion, Vascular/mortality
- Graft Occlusion, Vascular/physiopathology
- Graft Occlusion, Vascular/prevention & control
- Humans
- Imaging, Three-Dimensional
- Male
- Middle Aged
- Risk Factors
- Saphenous Vein/transplantation
- Tomography, X-Ray Computed/methods
- Vascular Patency
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Affiliation(s)
- Peter Bergmann
- Department of Surgery, Division of Cardiac Surgery, Medical University of Graz, Austria.
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4
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Chung CH, Lee JW, Kang JK, Song H, Choo SJ, Song MG. Mid-term follow up of patients using the St. Jude Medical Aortic Connector System for proximal vein graft in CABG. J Korean Med Sci 2006; 21:849-53. [PMID: 17043418 PMCID: PMC2721995 DOI: 10.3346/jkms.2006.21.5.849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The aortic connector system may reduce stroke during proximal venous anastomosis. However, the overall anastomotic patency rate has been generally reported to be low. From October 2002 to March 2004, 68 patients who received proximal anastomosis using the St. Jude Aortic Connector System were included in the study. There were 47 men and 21 women and their mean age was 65.68+/-6.68 yr old (52 to 85 yr). Grafts were evaluated by coronary angiography or multi-slice 16 channel 3-D CT at 6 days and at 6 months postoperatively. In the immediate postoperative period, no stenosis was observed by either angiography (n=22) or 3D CT (n=46). At 6-month postoperatively, we performed either angiography (n=7) or 3-D CT (n=52). Of these patients, 5 patients showed graft stenosis in the midportion, and 3 in the ostium. There were no stroke. Simple, and effective proximal anastomosis with good protection from cerebrovascular accident was achieved especially when calcification or atheromatous plaque was observed at the ascending aorta in the operation room. However, our mid term patency results raise concerns related to venous graft stenosis in the midportion. Therefore, longer follow up is recommended.
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Affiliation(s)
- Cheol Hyun Chung
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
| | - Jae Won Lee
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
| | - Joon Kyu Kang
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
| | - Hyun Song
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
| | - Suk Jung Choo
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
| | - Meong Gun Song
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
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5
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Inaba H, Higuchi K, Koseni K, Yamauchi H, Naganuma J. Use of an aortic connector system for vein grafting: intermediate outcomes. THE JAPANESE JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY : OFFICIAL PUBLICATION OF THE JAPANESE ASSOCIATION FOR THORACIC SURGERY = NIHON KYOBU GEKA GAKKAI ZASSHI 2005; 53:587-92. [PMID: 16363715 DOI: 10.1007/s11748-005-0143-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The aortic connector system was used to minimize cerebrovascular complications when performing the proximal anastomosis of vein grafts during coronary artery bypass grafting (CABG). The goal of this study was to investigate the intermediate outcomes of patients undergoing CABG with the aortic connector system. METHODS The aortic connector was used on nine patients undergoing CABG between November 2002 and July 2003. Intermediate outcomes of the patients were examined, and the results of coronary angiography, which were performed before patient discharge and at least 6 months after discharge, were evaluated. RESULTS There were no operative deaths or cerebrovascular accidents. One patient died 9 months after discharge, one patient had angina, and the remaining seven patients were asymptomatic. When evaluating the results of angiography performed before patient discharge, two of the 21 distal vein graft anastomoses were occluded (patency rate, 90.5%), but there was no stenosis or occlusion at the proximal anastomoses sites that were performed using the aortic connector. When evaluating the results of the second angiography performed after patient discharge, four of the eight proximal anastomoses were patent, one was completely occluded, two had 90% stenosis and one had 75% stenosis. Further, four of the 18 distal anastomoses were occluded (patency rate, 77.8%). There was no significant difference in graft flow or device size when comparing patients with patent vein grafts and those with stenotic or occluded vein grafts. CONCLUSION Intermediate outcomes of vein grafting using the aortic connector were suboptimal. Long-term outcome data are forthcoming.
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Affiliation(s)
- Hirotaka Inaba
- Department of Cardiac Surgery, Asahi General Hospital, Asahi, Chiba, Japan
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6
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Kitamura H, Okabayashi H, Hanyu M, Soga Y, Nomoto T, Johno H, Nakano J, Matsuo T, Kai M, Umehara E. Early and midterm patency of the proximal anastomoses of saphenous vein grafts made with a Symmetry Aortic Connector System. J Thorac Cardiovasc Surg 2005; 130:1028-31. [PMID: 16214515 DOI: 10.1016/j.jtcvs.2005.05.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2005] [Revised: 05/22/2005] [Accepted: 05/22/2005] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate (1) the early and midterm patency rates in saphenous vein grafts that were anastomosed with the Symmetry Aortic Connector System (St Jude Medical, Inc, St Paul, Minn) and (2) risk factors for graft occlusion. METHODS Thirty-one patients underwent off-pump coronary artery bypass grafting for proximal saphenous vein graft anastomoses with the aortic connector system. Intraoperative graft flow was studied with transit time flowmetry, and angiography was performed before discharge in 29 cases. Midterm (at least 1 year after the operation) saphenous vein graft patency was assessed by coronary angiography or 3-dimensional coronary computed tomography in 27 cases. RESULTS Postoperative angiography demonstrated a 100% patency rate and no significant stenosis at the connector-anastomosed sites. The 1-year patency rate of the saphenous vein grafts with the aortic connector system was 92.6%, with 2 cases of saphenous vein graft occlusion. Both of these cases had low graft flow and poor left ventricular function documented during the operation. CONCLUSION Once surgical errors had been ruled out, the 1-year patency rate of proximal saphenous vein grafts anastomosed with the aortic connector system was favorable. Poor left ventricular function and low graft flow during the operation were risk factors for midterm graft occlusion. Selection of the target vessel and its runoff may also be an important determinant of long-term patency.
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Affiliation(s)
- Hideki Kitamura
- Department of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyusyu City, Fukuoka, Japan.
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7
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Reuthebuch O, Kadner A, Turina MI. Reply. Ann Thorac Surg 2004. [DOI: 10.1016/j.athoracsur.2003.12.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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8
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Melero JM, Porras C, Such M, Olalla E, Alonso J. Severe Stenosis of Anastomoses by Using the Symmetry Aortic Connector System. Ann Thorac Surg 2004; 78:1831-3. [PMID: 15511489 DOI: 10.1016/j.athoracsur.2003.07.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/17/2003] [Indexed: 11/19/2022]
Abstract
The St. Jude Medical Symmetry Aortic Connector System was developed to create the proximal vein graft anastomoses in coronary artery bypass grafting. We describe three symptomatic patients with severe stenosis of the proximal anastomosis several months after using the Symmetry aortic connector system. Intravascular ultrasound study showed anastomotic neointimal hyperplasia.
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Affiliation(s)
- Jose M Melero
- Department of Cardiac Surgery, Virgen de la Victoria University Hospital, Málaga, Spain.
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9
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Kitamura H, Okabayashi H, Hanyu M, Nakano J, Kono S, Nomoto T, Nagasawa A, Sakaguchi H, Johno H, Matsuo T. Early results and problems with St. Jude Medical Symmetry bypass system in Japan. Asian Cardiovasc Thorac Ann 2004; 12:236-8. [PMID: 15353463 DOI: 10.1177/021849230401200312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The early results of coronary artery grafting with an aortic connector system were assessed in Japanese patients. From May 2002 through April 2003, 24 consecutive patients underwent off-pump coronary artery bypass using an aortic connector system. Another patient was excluded because the saphenous vein was insufficient for the smallest available aortic connector system. Saphenous veins were harvested from the thigh in 17 (70.8%) patients, and from the lower leg in 7. The size of the aortic connector system was 4.5-5.0 mm in 19 (79.2%) patients. Intraoperative epiaortic echo indicated that a side-clamp was contraindicated in 15 cases. Hemostasis was instantaneous in all patients. There were no hospital deaths and no neurologic morbidity. Pre-discharge angiography revealed 100% patency of the anastomoses. Use of the aortic connector system demonstrated excellent early results with low neurologic morbidity even when employed in the context of an atheromatous ascending aorta. However, smaller sizes of the device are required for some Japanese patients.
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Affiliation(s)
- Hideki Kitamura
- Cardiovascular Surgery, Kokura Memorial Hospital, Fukuoka, Japan.
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10
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Redaelli A, Maisano F, Ligorio G, Cattaneo E, Montevecchi FM, Alfieri O. 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 2004; 128:117-23. [PMID: 15224030 DOI: 10.1016/j.jtcvs.2004.02.039] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND The efficacy of the St Jude Medical Symmetry aortic connector (St Jude Medical, Inc, St Paul, Minn) for coronary artery bypass is currently debated. Potential drawbacks are the biocompatibility of the endoluminal device, the need for graft manipulation during the procedure, and the 90 degrees offset of the vein graft from the ascending aorta, which may induce graft kinking and abnormal fluid dynamics. In this article, a computational approach was designed to investigate the fluid dynamics pattern at the proximal graft. METHODS Four models of hand-sewn anastomoses and two models of automated anastomoses were constructed; a finite volume technique was used to simulate realistic graft fluid dynamics, including aortic compliance and proper aortic and graft flow rates. The anastomosis geometry performance was analyzed by calculating time-averaged wall shear stress and the oscillating shear index at the toe and heel regions of the proximal graft. RESULTS Time-averaged wall shear stress was significantly lower in the hand-sewn anastomosis models than in the two models that simulated the use of the aortic connector (0.38 +/- 0.07 Pa vs 1.32 +/- 0.4 Pa). Higher oscillating shear index values were calculated in the hand-sewn anastomosis models (0.15 +/- 0.02 Pa vs 0.06 +/- 0.02 Pa). CONCLUSIONS Automated anastomosis geometry is associated with less critical fluid dynamics than with conventional hand-sewn anastomosis: the shape of the proximal graft induces more physiological wall shear stresses and less oscillating flow, suggesting a lower risk of atherosclerotic plaque and intimal hyperplasia as compared with conventional anastomosis geometry. Therefore, the reported early thrombosis and late failure of the St Jude Medical aortic connector anastomoses are not related to unfavorable fluid dynamics.
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Affiliation(s)
- A Redaelli
- Department of Bioengineering, Politecnico di Milano, Milan, Italy.
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11
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Reuthebuch O, Kadner A, Lachat M, Künzli A, Schurr UP, Turina MI. Early bypass occlusion after deployment of nitinol connector devices. J Thorac Cardiovasc Surg 2004; 127:1421-6. [PMID: 15116002 DOI: 10.1016/j.jtcvs.2004.01.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Reducing the negative side effects associated with extracorporeal circulation is the major advantage of off-pump revascularization. However, side clamping of a calcified aorta for proximal anastomoses can cause emboli, resulting in neurologic damage. This problem has been addressed by introducing a mechanical anastomosis device (Symmetry, St Jude Medical) that allows vein-to-aorta anastomosis without manipulating the aorta. This report describes our experience with this device. METHODS Between June 2001 and April 2002, 77 connectors (1.3 per patient) were deployed in 61 patients (51 men and 10 women; mean age, 68 +/- 8.6 years) undergoing off-pump coronary artery bypass grafting or beating-heart revascularization. Intraoperative quality assessment included transit-time flow measurement (Medistim) and indocyanine green-based angiography (Spy, Novadaq). RESULTS The surgeons were meticulously trained in loading of the device. No postoperative neurologic deficits were detected. Fifty-three patients had an uneventful course. However, 8 (13.1%) patients with 12 implanted connectors were symptomatic within 8 months (1 day to 8 months). Angiography revealed significant (95%) stenosis or even occlusion of the proximal vein-to-aorta anastomosis at the level of all connectors. Four patients underwent reoperation (2 dilated-stented and 2 treated with drugs). CONCLUSION On the basis of these observations, the routine use of the connector was halted at our institution. At the moment, the use of this therapy is reserved for patients with severely calcified aortas with no technical alternative. Further investigations appear necessary to evaluate the clinical patterns of this otherwise promising technology.
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Affiliation(s)
- Oliver Reuthebuch
- Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland.
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12
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Lahtinen J, Biancari F, Mosorin M, Heikkinen J, Rainio P, Juvonen TS, Lepojärvi M. Fatal complications after use of the symmetry aortic connector in coronary artery bypass surgery. Ann Thorac Surg 2004; 77:1817-9. [PMID: 15111196 DOI: 10.1016/s0003-4975(03)01291-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/06/2003] [Indexed: 11/23/2022]
Abstract
During the last 2 years, 103 aortic saphenous vein graft anastomoses were performed in 68 patients undergoing off-pump coronary artery bypass by using the Symmetry Bypass System Aortic Connector. Of these patients, 2 died during the early postoperative period. In the first patient, after an episode of ventricular fibrillation and closed-chest cardiac massage, the sternum was opened and hemopericardium secondary to leakage of the proximal anastomotic device was found. The second patient died of ascending aortic dissection, the tear of which was likely to have originated from the proximal anastomotic site.
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Affiliation(s)
- Jarmo Lahtinen
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, University of Oulu and Oulu University Hospital, Oulu, Finland
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13
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Cline SL, Guduvalli A, Kalaria VG. Early ostial saphenous vein graft stenosis associated with the use of Symmetry sutureless aortic proximal anastomosis device: Successful percutaneous revascularization. Catheter Cardiovasc Interv 2004; 62:203-8. [PMID: 15170712 DOI: 10.1002/ccd.20048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A recent advance in technology permits the creation of sutureless proximal aortic anastomosis during coronary artery bypass graft surgery. This new tool has significant potential benefit by minimizing aortic manipulation with subsequent reduction in neuroembolization. Implantation of a nitinol-based proximal aortic connector (Symmetry) has a potential to elicit intimal hyperplastic reaction analogous to restenosis after coronary stent placement. We report cases of early vein graft stenosis in association with the use of the Symmetry device. Three patients suffered from severe ostial stenosis within 6 months of bypass surgery with symptomatic presentation. Of these three patients, two underwent successful percutaneous revascularization. Fluoroscopic star-shaped appearance of the metallic Symmetry allows device recognition during angiography. We review current data regarding graft patency with the use of Symmetry device and discuss technical issues to address specific problems during percutaneous revascularization.
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MESH Headings
- Anastomosis, Surgical/instrumentation
- Angina, Unstable/diagnostic imaging
- Angina, Unstable/surgery
- Angioplasty, Balloon, Coronary
- Aorta/pathology
- Aorta/surgery
- Coronary Angiography
- Coronary Artery Disease/diagnostic imaging
- Coronary Artery Disease/surgery
- Female
- Graft Occlusion, Vascular/diagnostic imaging
- Graft Occlusion, Vascular/etiology
- Graft Occlusion, Vascular/therapy
- Humans
- Male
- Middle Aged
- Saphenous Vein/diagnostic imaging
- Saphenous Vein/pathology
- Saphenous Vein/surgery
- Suture Techniques/adverse effects
- Ventricular Dysfunction, Left/diagnostic imaging
- Ventricular Dysfunction, Left/surgery
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Affiliation(s)
- Sharon L Cline
- Krannert Institute of Cardiology, Clarian Cardiovascular Center, Department of Medicine, Indiana University, Indianapolis, Indiana 46202, USA.
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14
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Anyanwu AC. Authors should list confounding factors and alternative explanations for adverse events seen with new technologies. J Thorac Cardiovasc Surg 2003; 126:1663-4; author reply 1664. [PMID: 14666059 DOI: 10.1016/s0022-5223(03)01051-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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