title: Initial experience with proximal anastomoses performed with a mechanical connector.
abstract: BACKGROUND
  The Symmetry Bypass System Aortic Connector (St Jude Medical, Inc) is a novel device for the construction of sutureless proximal anastomoses. The connector allows attachment of saphenous vein grafts to the aorta without requiring aortic clamping. We report our initial clinical experience with this device.
  
  
  METHODS
  In a 2-month period from May to July 2001, a total of 139 consecutive proximal anastomoses were performed in 67 patients using the connector. All procedures were performed on a beating heart without cardiopulmonary bypass or any aortic clamping. Intraoperative variables and postoperative results were prospectively collected and retrospectively analyzed.
  
  
  RESULTS
  Of 139 consecutive proximal anastomoses 138 (99.3%) were successfully completed with the device. One anastomosis required suture revision because of misdeployment. Six anastomoses (4.3%) required an additional suture for leak. Predeployment problems included connector loading/preparation malfunction in 10 grafts (7.2%), five because of human error and five technical failure. There was no operative mortality, perioperative myocardial infarction, or stroke. Vessels bypassed included the circumflex system (n = 59), right coronary artery and branches (n = 48), diagonal branch (n = 26), and left anterior descending coronary artery (n = 6). At a mean follow-up of 7 months, survival was 94.1% and survival free of major adverse cardiac and cerebrovascular events (MACCE) was 88.1%.
  
  
  CONCLUSIONS
  Initial clinical experience with a sutureless proximal saphenous vein graft to aorta anastomosis performed with a mechanical connector demonstrates safety, reliability, and ease of use. Surmounting a brief learning curve improves the subtleties of device loading and deployment. Further benefits will be determined in an ongoing randomized study.
authors.affiliation: Cardiopulmonary Research and Science Technology Institute, Medical City Dallas Hospital, Dallas, Texas, USA. mjmack@earthlink.net
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mack
authors.forename: Robert W
authors.initials: RW
authors.lastname: Emery
authors.forename: Laura R
authors.initials: LR
authors.lastname: Ley
authors.forename: Peter A
authors.initials: PA
authors.lastname: Cole
authors.forename: Allie
authors.initials: A
authors.lastname: Leonard
authors.forename: James R
authors.initials: JR
authors.lastname: Edgerton
authors.forename: Todd M
authors.initials: TM
authors.lastname: Dewey
authors.forename: Mitchell J
authors.initials: MJ
authors.lastname: Magee
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Flavin
mesh_terms: D000328:Adult; D000368:Aged; D000497:Alloys; D000714:Anastomosis, Surgical / Q000295:instrumentation*; D001013:Aorta, Thoracic / Q000601:surgery; D001027:Aortography; D001026:Coronary Artery Bypass / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D007431:Intraoperative Complications / Q000175:diagnosis / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology; D011446:Prospective Studies; D013536:Suture Techniques / Q000295:instrumentation*; D014680:Veins / Q000637:transplantation
chemical_list: D000497:Alloys; C013616:nitinol