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J Thorac Cardiovasc Surg 2002;123:783-787
© 2002 The American Association for Thoracic Surgery

Evolving Technology (ET)

Early experience of coronary artery bypass grafting with a new self-closing clip device

From the Division of Cardiothoracic Surgery, The Ohio State University Medical Center, Columbus, Ohio.

Received for publication July 12, 2001. Revisions requested Aug 28, 2001; revisions received Sept 10, 2001. Accepted for publication Sept 12, 2001. Address for reprints: Randall K. Wolf, MD, Division of Cardiothoracic Surgery, The Ohio State University Medical Center, 410 W 10th Ave, Doan Hall—Room N816, Columbus OH 43210 (E-mail: wolf-4{at}medctr.osu.edu).

Objective: We are in the midst of development of several new anastomotic devices for use in coronary artery bypass grafting surgery. This study was designed to examine one of these devices (a new self-closing clip) for left internal thoracic artery-left anterior descending coronary artery anastomosis. Its feasibility and the quality of anastomosis were evaluated.
Methods: Fourteen patients who underwent first-time elective coronary artery bypass surgery were enrolled between July and December 2000. The left internal thoracic artery was anastomosed to the left anterior descending coronary artery in an interrupted manner with Coalescent U-clips (Coalescent Surgical, Inc, Sunnyvale, Calif). Immediate patency was checked with a transit-time flowmeter. Selective angiography was performed 6 months after surgical intervention.
Results: Five patients underwent on-pump coronary bypass grafting, 9 on the beating heart. One patient was excluded from the study intraoperatively because of a poor target site necessitating a 2-cm-long anastomosis. Left internal thoracic artery-left anterior descending artery anastomoses were created with an average of 11.8 clips in 15.9 minutes. Mean graft flow was 45.6 mL/min. Neither conversion to standard suture technique nor revision of anastomosis was necessary. There tended to be a learning curve in the anastomosis on the beating heart. Postoperative lengths of stay in the intensive care unit and the hospital were 20.7 hours and 3.9 days, respectively. Neither death nor major complication was seen, except for temporary atrial fibrillation in 2 patients. Graft patency at 6 months was 100% (FitzGibbon grade A).
Conclusion: Left internal thoracic artery—left anterior descending artery anastomoses can be created safely and effectively with new self-closing clips on the beating, as well as the arrested, heart. Midterm patency was shown to be perfect by means of angiography.

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