title: Video-assisted multivessel revascularization through a left anterior small thoracotomy approach with the Symmetry Aortic Connector System.
abstract: OBJECTIVE
  We sought to demonstrate the applicability of video-assisted multivessel revascularization through a left anterior small thoracotomy approach with the use of the Symmetry Aortic Connector System (St Jude Medical Anastomotic Technology Group, Inc, St Paul, Minn) as an alternative to the standard median sternotomy approach and to evaluate predischarge angiographically documented graft patency.
  
  
  METHODS
  From October 2001 through February 2002, a total of 15 patients with triple-vessel disease were operated on through a left anterior small thoracotomy approach with video-assisted port-access construction of proximal aorta-to-saphenous vein anastomoses with the Symmetry Aortic Connector System and cardiopulmonary bypass with femoral cannulation and without cardioplegic arrest. There were 9 male and 6 female subjects with a mean age of 68.3 +/- 3.6 years and an average ejection fraction of 55.8% +/- 19.6%. Subject inclusion criteria consisted of female sex (initially but not throughout the study), coronary artery reoperations, and sternal bone disease. Subject exclusion criteria consisted of an age younger than 65 years, extensive atheromatous plaques in the ascending aorta, and aortoiliac occlusive disease. All but 1 patient underwent angiographic patency evaluation before discharge.
  
  
  RESULTS
  Fifteen operations were performed successfully without any deaths. Twenty-nine sutureless proximal anastomoses were performed, with an average of 3.13 +/- 0.62 distal anastomoses per patient. Eleven (73%) patients underwent a fast track protocol with extubation in the operating room. We did not observe any instances of low cardiac output syndrome, stroke, renal insufficiency, wound complication, or perioperative myocardial infarction. A single episode of atrial fibrillation occurred in this group. Angiographic assessment of 44 bypass grafts and target arteries was performed, and 86% of those examined were widely patent (FitzGibbon score A).
  
  
  CONCLUSIONS
  We have demonstrated a potential advantage of the sutureless Symmetry Aortic Connector System as a suitable approach that affords minimal access. Video-assisted multivessel revascularization through a left anterior small thoracotomy approach with an automated mechanical anastomosis device is particularly useful in patients undergoing coronary artery bypass reoperations or those at risk of poor sternal healing or infection. This approach seems to be a safe alternative to standard median sternotomy.
authors.affiliation: Department of Cardiovascular Surgery and Internal Department, Charles University Teaching Hospital, First Medical Faculty, Prague, Czech Republic.
authors.forename: Michal
authors.initials: M
authors.lastname: Semrád
authors.forename: Petr
authors.initials: P
authors.lastname: Bodlák
authors.forename: Martin
authors.initials: M
authors.lastname: Stríteský
authors.forename: Vladimír
authors.initials: V
authors.lastname: Vondrácek
authors.forename: Tomás
authors.initials: T
authors.lastname: Urban
authors.forename: Petra
authors.initials: P
authors.lastname: Vyhnalová
authors.forename: Frantisek
authors.initials: F
authors.lastname: Holm
authors.forename: Ivan
authors.initials: I
authors.lastname: Vanek
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000295:instrumentation / Q000379:methods; D001011:Aorta / Q000601:surgery; D001026:Coronary Artery Bypass / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D012501:Saphenous Vein / Q000637:transplantation; D020775:Thoracic Surgery, Video-Assisted; D013908:Thoracotomy