title: Two generations of the St. Jude Medical ATG coronary connector systems for coronary artery anastomoses in coronary artery bypass grafting.
abstract: BACKGROUND
  In the past, coronary anastomoses have been performed using running and, occasionally, interrupted non-resorbable sutures. Recently, special interest has developed in mechanical anastomotic devices to facilitate minimal invasive techniques or limited access surgery. The experience with two series of patients undergoing coronary artery bypass grafting (CABG) using the St. Jude Medical ATG coronary connector systems (investigational stainless steel device, not yet commercially available) for vein-to-coronary artery anastomoses is reported here.
  
  
  METHODS
  Between November 2000 and April 2002, we evaluated two generations of distal coronary connector systems in 19 patients who were scheduled for multivessel CABG. One vein graft-to-coronary artery anastomosis per patient was performed with a stainless steel mechanical connector, in an ongoing investigational study. Although these two generations of the St. Jude Medical ATG coronary connectors have the same underlying construction, somewhat cumbersome loading of the first-generation system led to simplification of the second-generation system, which is currently evaluated.
  
  
  RESULTS
  With the first generation of distal connector, hemostasis was instantaneous in all cases, and all anastomoses were patent at the end of the procedure. However, retrograde flow to the native coronary artery was restricted in 1 patient. The connector was removed, and the anastomosis was performed with a running suture at the same site. Three-month angiography or magnetic resonance imaging angiography was available in 11 patients with 10 patent connector grafts. With the second-generation connectors one of five had to be removed because of leakage, and the anastomosis could be sutured at the same site. The other four connector anastomoses were patent and hemostatic at the end of the procedure.
  
  
  CONCLUSIONS
  The St. Jude Medical ATG coronary connector system is an effective device for sutureless vein graft to coronary artery anastomoses in CABG. The second-generation system presents a further development eliminating some drawbacks of the first generation such as cumbersome, time-consuming loading as well as suitability for smaller coronary arteries. These connectors allow construction of geometrically round anastomoses and theoretically may also be suitable for sequential anastomoses. After tremendous research and development efforts, an optimized mechanical connection system for small vessel anastomoses has been introduced into clinical investigation. This represents a major step in the era of sutureless vascular connections in cardiac surgery.
authors.affiliation: Clinic for Cardiovascular Surgery and Department of Cardiology, University Hospital, Bern, Switzerland. friedrich.eckstein@insel.ch
authors.forename: Friedrich S
authors.initials: FS
authors.lastname: Eckstein
authors.forename: Luis F
authors.initials: LF
authors.lastname: Bonilla
authors.forename: Hartzell
authors.initials: H
authors.lastname: Schaff
authors.forename: Lars
authors.initials: L
authors.lastname: Englberger
authors.forename: Stephan
authors.initials: S
authors.lastname: Windecker
authors.forename: Paul
authors.initials: P
authors.lastname: Hindrichs
authors.forename: Thierry P
authors.initials: TP
authors.lastname: Carrel
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000295:instrumentation*; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000295:instrumentation*; D003326:Coronary Circulation; D004867:Equipment Design; D006487:Hemostasis / Q000502:physiology; D006801:Humans; D018810:Magnetic Resonance Angiography; D013906:Thoracoscopy; D014654:Vascular Patency