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J Thorac Cardiovasc Surg 2003;125:27-29
© 2003 The American Association for Thoracic Surgery

Editorials

Defining the role of anastomotic devices in coronary bypass surgery

From the Division of Cardiovascular Surgery, Toronto General Hospital, University Health Network, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.

Received for publication Sept 13, 2002. Accepted for publication Sept 24, 2002. Address for reprints: Terrence M. Yau, MD, MSc, 13EN-239, Toronto General Hospital, 200 Elizabeth St, Toronto, Ontario, Canada M5G 2C4 (E-mail: terry.yau@utoronto.ca).

The first 300 words of the full text of this article appear below.

	Introduction

 

View larger version (108K): [in this window] [in a new window]   Dr Yau

Coronary artery bypass surgery (CABG) has undergone a host of changes since its initial description by Favaloro. Throughout the progressive refinements of cardiopulmonary bypass technologies, myocardial protection strategies, and the rise in popularity of off-pump coronary bypass (OPCAB) and other techniques of "less-invasive" surgery, the actual technical aspects of creating a coronary anastomosis have remained relatively constant. A new class of anastomotic devices may change this process and, with it, some of our fundamental assumptions about what is required to perform this operation.

	Potential advantages and applications

 
Although the advantages of these anastomotic connectors have yet to be fully realized in the first generation devices that are now available, their potential is intriguing. Device manufacturers hope to enable the creation of anastomoses in seconds, not minutes, with completely uniform geometry, reproducibility, and the requirement for relatively little surgeon training. If proximal anastomoses can be performed in 2 to 5 seconds and distal anastomoses in 1 to 2 minutes, our typical day in the operating room may change dramatically! But faster anastomoses may have greater benefits than getting us to lunch more quickly or enabling us to do more cases. Reduced ischemic times, whether global or regional, may reduce myocardial injury and improve operative outcomes. Quicker anastomoses and more rapid reperfusion in patients having ongoing myocardial ischemia or infarction should translate into greater myocardial salvage. The ability to perform distal anastomoses rapidly may also facilitate the performance of OPCAB, when cardiac positioning and stabilization must be maintained for only a fraction of the time that is now necessary. Finally, in a health care environment in which cost containment is a major imperative, reduced operating room times can improve an institution's bottom line.

The most intuitively attractive application of devices like the Symmetry Aortic Connector System (St . . . [Full Text of this Article]

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