Anastomotic devices in coronary artery surgery: it is about the anastomosis?

Clinical outcomes of automated anastomotic devices: A metanalysis

Background and Aims

We investigated neurological events, graft patency, major adverse cardiovascular events (MACEs), and mortality at 1 year following coronary artery bypass grafting (CABG) surgery using automated proximal anastomotic devices (APADs) and compared the overall rates with the current literature.

Methods

A systematic review of all available reports of APADs use in the literature was conducted. Cumulative incidence and 95% confidence interval (CI) were the main statistical indexes. Nine observational studies encompassing a total of 718 patients were included at the end of the selection process.

Results

The cumulative event rate of neurological complications was 4.8% (lower‐upper limits: 2.8‐8.0, P < .001; I² = 72.907%, P = .002; Egger's test: intercept = –2.47, P = 0.16; Begg and Mazumdar test: τ = −0.20, p = 0.57). Graft patency was 90.5% (80.4 to 95.7, P < .001; I² = 76.823%, P = .005; Egger's test: intercept = –3.04, P = .10; Begg and Mazumdar test: τ = −0.67, P = .17). Furthermore, the overall incidence of MACEs was 3.7% (1.3‐10.4, P < .001; I² = 51.556%, P = .103; Egger's test: intercept = –1.98, P =  < .11; Begg and Mazumdar test: τ = −0.67, P = .17). Finally, mortality within 1 year was 5% (3.5‐7, P < .001; I² = 29.675%, P = .202; Egger's test: intercept = –0.91, P = .62; Begg and Mazumdar test: τ = −0.04, P = .88).

Conclusions

APADs do not seem to be correlated with a reduction of either neurological events or mortality. By contrast, these tools showed satisfactory one‐year graft patency and a low incidence of MACEs. Further research on this topic is warranted.

[Analysis of flowmetric parameters of blood flow through coronary bypass grafts in high-risk surgical patients]

Coronary artery bypass grafting is a widely used cardiosurgical intervention which may be performed either on the arrested heart in conditions of artificial circulation or on the beating heart without artificial circulation. However, in a series of works, the results of bypass grafting using both techniques had no significant differences. In our article, we analyse the flowmetric parameters of blood flow through the coronary bypass grafts in high-surgical risk patients presenting with ischaemic heart disease and undergoing coronary artery bypass grafting in conditions of artificial circulation and on the beating heart. For this purpose, a total of 148 patients enrolled into the study were divided into 2 groups depending on the technique of surgical treatment. The obtained statistical data showed comparable results in the both groups, however, operative interventions on the beating heart made it possible to significantly decrease the risk of the development of the majority of complications.