title: Clinical and six-month angiographic evaluation of coronary arterial graft interrupted anastomoses by use of a self-closing clip device: a multicenter prospective clinical trial.
abstract: OBJECTIVE
  To evaluate the safety and effectiveness of a self-closing surgical clip with an interrupted technique in left internal thoracic artery to left anterior descending artery bypass grafting.
  
  
  METHODS
  Eighty-two patients were enrolled and treated (February 2000 through August 2001) in a prospective, nonrandomized, multicenter trial. Left internal thoracic artery to left anterior descending artery anastomoses were performed in 60 off-pump coronary artery bypasses (73%), 12 conventional coronary artery bypass grafting (15%), and 10 minimally invasive direct coronary artery bypass (12%) procedures. Angiograms (64 to 383 days, mean 200 days) were obtained on 63 patients (77%). Qualitative and quantitative angiographic assessment was performed by an independent core laboratory.
  
  
  RESULTS
  The self-closing surgical clip was used for 82 left internal thoracic artery to left anterior descending artery interrupted anastomoses without the requirement for knot tying or primary suture management. Minimum left internal thoracic artery to left anterior descending artery anastomosis time was 3 minutes. There was one perioperative and one late death (both not heart related) and one reexploration for bleeding unrelated to the anastomotic site. FitzGibbon grades were as follows: A (n = 60, 95.2%), B (n = 3, 4.8%) including one kinked left internal thoracic artery, and O (n = 0, 0%). Quantitative analysis (n = 57) showed mean lumen diameters of left internal thoracic artery proximal to the anastomosis of 2.1 mm, at anastomosis of 2.0 mm, and in the left anterior descending artery distal to the anastomosis of 1.9 mm. The average ratio of the anastomosis to the left anterior descending artery diameter was 1.14 (0.45 to 1.93). Anastomotic stenosis as a percentage of average left internal thoracic artery to left anterior descending artery diameter was -2.3%, comparing favorably with results (23% to 24%) reported from the Patency, Outcomes, Economics, Minimally invasive direct coronary artery (POEM) bypass study.
  
  
  CONCLUSIONS
  The interrupted technique, facilitated by a self-closing anastomotic clip, yields favorable 6-month angiographic results when compared with other published studies.
authors.affiliation: Ohio State University, Columbus, Ohio 43210, USA. wolf-4@medctr.osu.edu
authors.forename: Randall K
authors.initials: RK
authors.lastname: Wolf
authors.forename: Edwin L
authors.initials: EL
authors.lastname: Alderman
authors.forename: Michael P
authors.initials: MP
authors.lastname: Caskey
authors.forename: Allen R
authors.initials: AR
authors.lastname: Raczkowski
authors.forename: Mercedes K
authors.initials: MK
authors.lastname: Dullum
authors.forename: Dwight C
authors.initials: DC
authors.lastname: Lundell
authors.forename: Arthur C
authors.initials: AC
authors.lastname: Hill
authors.forename: Nan
authors.initials: N
authors.lastname: Wang
authors.forename: Michael A
authors.initials: MA
authors.lastname: Daniel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D001783:Blood Flow Velocity / Q000502:physiology; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000295:instrumentation*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D003331:Coronary Vessels / Q000503:physiopathology / Q000601:surgery*; D004869:Equipment Safety / Q000295:instrumentation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D011446:Prospective Studies; D012720:Severity of Illness Index; D013525:Surgical Instruments; D016896:Treatment Outcome; D014654:Vascular Patency / Q000502:physiology