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J Thorac Cardiovasc Surg 2003;126:1555-1560
© 2003 The American Association for Thoracic Surgery

Evolving technology

Evaluation of a novel sutureless anastomotic connector: From endothelial function to mid-term clinical and angiographic follow-up

^a Division of Cardiovascular Surgery, Toronto General Hospital, University Health Network, Department of Surgery, University of Toronto and the Richard Lewar/Heart and Stroke Foundation Centre of Excellence, Toronto, Ontario, Canada
^b Division of Cardiology, Mount Sinai Hospital, Department of Medicine, University of Toronto, Toronto, Ontario, Canada

Received for publication June 18, 2002; revisions received August 19, 2002; revisions received June 2, 2003; accepted for publication June 16, 2003.

^* Address for reprints: Terrence M. Yau, MD, MSc, FRCSC, Toronto General Hospital, 13EN-239, 200 Elizabeth St, Toronto, Ontario M5G 2C4, Canada
terry.yau{at}utoronto.ca

OBJECTIVES: We evaluated the effect of the St Jude Medical sutureless anastomotic connector on endothelium-dependent and -independent saphenous vein graft relaxation, as well as on clinical outcomes and graft patency in patients.

METHODS: Human saphenous vein grafts were assigned to control or connector groups (loaded for 1 or 5 minutes; n = 18). Isometric dose-response curves to endothelium-dependent and -independent (sodium nitroprusside) vasodilators were constructed in saphenous vein grafts precontracted with phenylephrine. Thrombin-mediated vasorelaxation, an early determinant of saphenous vein graft failure, was also evaluated. Percent maximum relaxation was compared between groups. Patients in whom the St Jude Medical connector was employed underwent clinical follow-up, stress tests, and angiography 6 to 12 months postoperatively.

RESULTS: A23187-induced endothelium-mediated relaxation, sodium nitroprusside-induced endothelium-independent relaxation, and thrombin-mediated vasorelaxation did not differ between control and connector saphenous vein grafts at either time point studied. Twenty-seven patients received St Jude Medical connectors. There was no hospital mortality; patients were followed for 679 ± 241 days. There was 1 late death; the connector saphenous vein graft was patent at postmortem. All connector saphenous vein grafts were patent at follow-up angiography. Four grafts had stenoses (30%-60%), without symptoms or requirement for intervention. All hand-sewn saphenous vein grafts were also patent.

CONCLUSIONS: The St Jude Medical connector does not impair endothelium-dependent vasorelaxation. In patients, patency of the connector saphenous vein grafts 6 to 12 months postoperatively was 100% but 22% of grafts had non–flow-limiting stenoses at or near the connector. Further long-term studies are required to confirm the safety of the St Jude Medical connector with regards to endothelial function and restenosis.

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