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J Thorac Cardiovasc Surg 2003;125:S78-S79
© 2003 The American Association for Thoracic Surgery

Editorials

Enter the era of facilitated anastomotic devices for coronary bypass surgery

From the Department of Cardiothoracic Surgery, McGill University Health Center, Montreal, Quebec, Canada.

Received for publication Dec 19, 2000. Accepted for publication Dec 28, 2000. Address for reprints: Hani Shennib, MD, 1650 Cedar Ave, Room L9-121, Montreal, Quebec H3G 1A4, Canada.

The first 20% of the full text of this article appears below.

During the past 50 years and except for some attempts to use mechanical staplers by the Russian pioneer surgeon Kolosov, almost all proximal and distal aorta-coronary anastomoses have been done with conventional hand-held sutures. The comfort to surgeons in performing a reliable anastomosis with conventional suturing has led to its adoption as the gold standard and will likely be the principal reason for hesitancy in adopting alternate anastomotic methods. So why change?

Unquestionably, the principal impetus for change in our cardiac surgical practice has been the desire to offer patients less-invasive therapies, particularly in light of the rapid growth of percutaneous catheter-based interventional cardiology procedures. Since 1995 and with growing interest in developing platform technology for minimally invasive coronary artery bypass grafting (CABG), numerous concepts, devices, techniques, and technologies have been introduced. Some have been adopted. Others have vanished despite exhaustive efforts by their industrial promoters. (Surgeons may become excited quickly by new devices, but they also have the intellectual and practical honesty to abandon those that are of no benefit to their patients.) In fact, in a review of all the instruments developed—including cameras, scopes, retractors, occluders, and others—stabilizers for coronary artery anastomosis stand alone as the most significant contributors to the growth of beating-heart CABG. Of all the innovative technology to be considered in the near future, anastomotic devices, in my opinion, will have the greatest impact on the practice of CABG.

In general, for any anastomotic . . . [Full Text of this Article]