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Eur J Cardiothorac Surg 2005;27:579-583
© 2005 Elsevier Science NL

Decreased intermediate term patency of automated proximal anastomoses evaluated by sequential ultrafast CT

^a Department of Thoracic and Cardiovascular Surgery, JW Goethe University Clinic, Frankfurt, Germany
^b Department of Radiology, JW Goethe University Clinic, Frankfurt, Germany

Received 14 February 2004; received in revised form 14 December 2004; accepted 29 December 2004.

^* Corresponding author. Address: Department of Thoracic and Cardiovascular Surgery, JW Goethe University of Frankfurt, Theodor Stern Kai 7, 60590 Frankfurt, Germany. Tel.: +49 69 6301 5850; fax: +49 69 6301 5849. (E-mail: md.md{at}gmx.de).

Objective: The Symmetry^TM aortic connector creates proximal anastomoses of saphenous vein grafts using a nitinol implant. The device avoids partial clamping and thus possibly reduces neurologic complications. To evaluate graft patency, a single surgeon randomised study was performed in our institution. Methods: Seventy-seven patients were randomised either to automated proximal anastomoses (group I, n=39, 61 vein grafts connected using the aortic connector, 47 as single, 15 as sequential bypasses) or controls (group II, n=38, 62 proximal anastomoses handsewn, 46 as single, 16 as sequential bypasses). Ultrafast CT-scans were performed on postoperative day 5 in 34 patients of group I and 16 patients of group II to evaluate early graft patency. Intermediate term patency was evaluated with ultrafast CT-scan in 30 patients of group I (46 grafts) and 25 patients of group II (39 grafts) 1 year after the operation. Results: Two early graft occlusions were detected in group I (3.8%). In group II all evaluated grafts were patent 5 days after surgery. 11.4 months after surgery, seven out of 46 grafts were found occluded (15.2%) in group I. In the control group, only one occlusion was detected (2.6%). Conclusions: We observed a trend towards an increased occlusion rate 1 year after surgery with automated connector devices. For evaluation of long-term patency larger patient groups have to be evaluated. Other benefits of these devices have to be proven to promote their clinical application.

Key Words: Proximal anastomotic devices • Patency • Coronary artery bypass grafting

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