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J Thorac Cardiovasc Surg 2001;121:854-858
© 2001 The American Association for Thoracic Surgery
Evolving Technology |
From the Division of Cardiac Surgery, University "G. D'Annunzio," Chieti, Italy,a and the Rambam Medical Center, Haifa, Israel.b
Received for publication May 4, 2000. Revisions requested Aug 22, 2000; revisions received Sept 20, 2000. Accepted for publication Nov 8, 2000. Address for reprints: Antonio Maria Calafiore, MD, "G. D'Annunzio" University, Department of Cardiac Surgery, "San Camillo de' Lellis" Hospital, Via C. Forlanini 50, 66100 Chieti, Italy (E-mail: calafiore{at}unich.it).
Background: Avoiding aortic side clamping in useful to avoid local particulate embolization. A device that allows a saphenous vein graft to be anastomosed to the aorta without aortic manipulation is clinically evaluated.
Methods and results: From July 1999 to March 2000, 17 patients who underwent myocardial revascularization had an aorta–saphenous vein graft anastomosis performed by means of an aortic anastomotic device. Eight were operated on with cardiopulmonary bypass and 9 without. The proximal anastomoses created by the aortic anastomotic device were performed before the institution of cardiopulmonary bypass or before the related distal anastomosis was performed. In 11 patients transcranial Doppler ultrasound was used. In 1 (6%) patient the saphenous vein graft was not deployed, and in 2 (12%) a single suture was added for minor bleeding. None of the 11 patients evaluated with transcranial Doppler ultrasound had evidence of particulate embolization during the procedure. No patient died or was reoperated on for bleeding. Six (35%) patients had a postoperative angiogram 48 ± 26 days after the operation that showed widely patent proximal anastomoses.
Conclusions: Use of an aortic anastomotic device allows a sutureless anastomosis to be created between the aorta and saphenous vein graft. The device could be used in totally endoscopic myocardial revascularization. A second-generation device is ready to solve the problems encountered and to increase the ease in handling the device.
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J. Thorac. Cardiovasc. Surg. 2001 121: 833-834.
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