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J Thorac Cardiovasc Surg 2003;125:1173-1174
© 2003 The American Association for Thoracic Surgery

Letters to the Editor

Symmetry aortic connector system

Division of Cardiothoracic Surgery, Albert Einstein Medical Center, Philadelphia, PA 19141

To the Editor:

I read with interest the article by Donsky and associates ¹ in which they outlined several misadventures with the Symmetry aortic connector system (St Jude Medical, Inc, St Paul, Minn). In our practice, we have an extensive series of off-pump coronary artery bypass operations in which the Symmetry connector has been used. Although the manufacturer has not recommended any anticoagulation regimen postoperatively, my colleagues and I routinely administer clopidogrel postoperatively for 6 weeks.

We justified this therapy after we demonstrated, at least by thrombelastography, a relative state of hypercoagulation after off-pump operations when compared with conventional cardiopulmonary bypass. ² Furthermore, after deployment of an intracoronary stent, it is standard to prescribe a postprocedure course of clopidogrel therapy (ie, CLASSICS trial ³). Since some of these stents are also composed of nitinol (ie, Scimed Radius stent, Boston Scientific, Boston, Mass), the management of a patient with an aortic connector should be no different from the documented protocol well described in the cardiology literature.

To date we have not experienced any complications with the aforementioned aortic connector and agree with the authors that the 2 cases that they described involved patients with complex disease and other mitigating factors. We therefore continue not only to use the connector but to promote its use to our colleagues.

References

1. Donsky AS, Schussler JM, Donsky MS, Roberts WC, Hamman BL. Thrombotic occlusion of the aortic ostia of saphenous venous grafts early after coronary artery bypass grafting by using the Symmetry aortic connector system. J Thorac Cardiovasc Surg. 2002;124:397-9.[Free Full Text]
   
2. Quigley RL, Fried DW, Salenger R, Pym J, Highbloom RY. Thrombelastographic changes in OPCAB surgical patients. Perfusion. 2002;17:363-7.[Abstract/Free Full Text]
   
3. Bertrand ME, Rupprecht HJ, Urban P, Gershlick AH, Investigators FT. Double-blind study of the safety of clopidogrel with and without a loading dose in combination with aspirin compared with ticlopidine in combination with aspirin after coronary stenting: the Clopidogrel Aspirin Stent International Cooperative Study (CLASSICS). Circulation. 2000;102:624-9.[Abstract/Free Full Text]
   

This article has been cited by other articles:

				R. L. Quigley Severe ostial saphenous vein graft disease leading to acute coronary syndromes after proximal aorto-saphenous anastomoses with the symmetry bypass connector device J. Am. Coll. Cardiol., September 1, 2004; 44(5): 1140 - 1141. [Full Text] [PDF]

				A. Redaelli, F. Maisano, G. Ligorio, E. Cattaneo, F.M. Montevecchi, and O. Alfieri Flow dynamics of the St Jude Medical Symmetry aortic connector vein graft anastomosis do not contribute to the risk of acute thrombosis J. Thorac. Cardiovasc. Surg., July 1, 2004; 128(1): 117 - 123. [Abstract] [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Quigley, R. L. Search for Related Content PubMed PubMed Citation Articles by Quigley, R. L.