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J Thorac Cardiovasc Surg 2005;130:1581-1585
© 2005 The American Association for Thoracic Surgery

Cardiopulmonary Support and Physiology

Cerebral microembolization during off-pump coronary artery bypass surgery with the Symmetry aortic connector device

Mona Skjelland, MD a , * , Jacob Bergsland, MD b , Runar Lundblad, MD, PhD c , Per Snorre Lingaas, MD c , Kjell Arne Rein, MD, PhD c , Steinar Halvorsen, MD b , Jan L. Svennevig, MD, PhD c , Erik Fosse, MD, PhD b , Rainer Brucher, PhD a , David Russell, MD, PhD, FRCPE a

a Department of Neurology,
b The Interventional Center,
c Department of Thoracic and Cardiovascular Surgery, Rikshospitalet University Hospital, Oslo, Norway

* Address for reprints: Mona Skjelland, MD, Department of Neurology, Rikshospitalet University Hospital, Oslo, Norway (Email: mona.skjelland{at}rikshospitalet.no).

OBJECTIVE: The use of aortic connector systems for proximal vein grafts in off-pump coronary artery bypass grafting might minimize aortic manipulation by eliminating the need for partial aortic clamping. The objective of this study was to asses whether use of a Symmetry connector (St Jude Medical, Inc, St Paul, Minn) reduced intraoperative cerebral embolization.

METHODS: Thirty-two consecutive patients underwent off-pump coronary artery bypass grafting. Sixteen patients received at least one mechanical proximal vein graft anastomosis with a Symmetry aortic connector system. Sixteen patients representing the control group underwent operations with standard suturing techniques using partial aortic clamping. During surgical intervention, all patients were monitored continuously with multifrequency transcranial Doppler scanning, which detected and differentiated cerebral emboli.

RESULTS: There were significantly more cerebral emboli in the Symmetry group (median, 36) compared with the control group (median, 11; P = .027). This was due to a higher number of gaseous emboli in the Symmetry group than in the control group (median, 27 vs 8; P = .014), whereas there was no significant difference regarding the number of solid emboli (median, 7 vs 3; P = .139).

CONCLUSION: Use of a Symmetry connector system during proximal vein graft anastomosis increased the number of emboli to the brain compared with a standard technique in coronary bypass surgery without cardiopulmonary bypass.

Abbreviations and Acronyms CABG = coronary artery bypass grafting; dEBR = difference embolus blood ratio (2.5 MHz-2.0 MHz); OPCAB = off-pump coronary artery bypass grafting




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