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J Thorac Cardiovasc Surg 2005;129:146-150
© 2005 The American Association for Thoracic Surgery
Evolving Technology |
Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
Received for publication December 16, 2003; revisions received February 22, 2004; accepted for publication February 26, 2004. * Address for reprints: Lars Wiklund, MD, PhD, Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, S-413 45 Gothenburg, Sweden (E-mail: lars.wiklund{at}medfak.gu.se).
OBJECTIVE: A new mechanical anastomotic device was evaluated, aiming at its future use in minimally invasive techniques or limited access surgery in patients undergoing coronary artery bypass grafting.
METHODS: Between April and December 2002, a total of 60 patients scheduled for elective multivessel bypass grafting were randomly assigned. One vein graft–coronary artery anastomosis per patient was either performed with the St Jude Medical ATG coronary connector system (n = 30; St Jude Medical Inc, St Paul, Minn) or hand sewn (n = 30). Selective coronary angiography or coronary magnetic resonance imaging of the studied graft and vessel was included in the 6-month follow-up.
RESULTS: Twenty-eight of the connectors were successfully implanted. Two patients were excluded from the study because of conversion to hand-sewn anastomoses. Six connector-made anastomoses were bleeding at the anastomotic site. At the time of follow-up (190 postoperative days), all control anastomoses and grafts were patent, whereas 26% of the connector anastomoses were occluded. One graft in each group was patent but with stenosis.
CONCLUSION: The St Jude Medical ATG coronary connector system for distal anastomoses represents a new concept for sutureless anastomoses in cardiac surgery. This randomized, controlled study shows lower graft patency for anastomoses performed with the connector than for hand-sewn control anastomoses. It illustrates the importance of controlled studies when evaluating new technical equipment in medicine.
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