Clinical, angiographic, and interventional follow-up of patients with aortic-saphenous vein graft connectors.
BACKGROUND
The use of aortic connectors for proximal saphenous vein bypass graft anastomoses eliminates the need for aortic clamping during coronary artery bypass grafting (CABG) and may reduce the incidence of stroke in the elderly and in patients with severe aortic atherosclerosis.


RESULTS
We studied 74 consecutive patients who received the Symmetry Bypass System aortic connector at the time of CABG. A total of 131 of 144 proximal vein graft anastomoses were performed with this device. The left internal mammary artery was used in 62 patients, and 61 patients had "off-pump" coronary revascularization. A total of 11 patients were readmitted with chest pain consistent with unstable angina 173+/-39 days after CABG. Five of the 11 patients had previous in-stent restenosis before CABG. At angiography, 20 saphenous vein bypass grafts containing 19 connectors were found to have severe stenosis (n=12) or occlusion (n=6) and were treated with angioplasty and stenting or medical therapy. Seven of 11 patients were readmitted 76+/-11 days later with recurrent chest pain and were found to have severe stenosis at the previously stented connector site. Six patients underwent angioplasty followed by brachytherapy. Three of these patients redeveloped chest pain and were readmitted 151+/-71 days later. Two patients were started on oral Rapamune, and one patient underwent redo-CABG.


CONCLUSIONS
Eleven of 74 patients who received aortic connectors at the time of CABG developed symptomatically significant stenosis or occlusion at the connector site shortly after CABG, requiring multiple repeat interventions, including brachytherapy.
Traverse
Jay H
JH
Minneapolis Cardiology Associates, Minneapolis Heart Institute at Abbott Northwestern Hospital, 920 East 28th Street, Suite 300, Minneapolis, Minn 55407, USA. trave004@tc.umn.edu
Mooney
Michael R
MR
Pedersen
Wesley R
WR
Madison
James D
JD
Flavin
Thomas F
TF
Kshettry
Vibhu R
VR
Henry
Timothy D
TD
Eales
Frazier
F
Joyce
Lyle D
LD
Emery
Robert W
RW
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001011:Aorta / Q000601:surgery; D001807:Blood Vessel Prosthesis / Q000009:adverse effects / Q000706:statistics & numerical data; D001918:Brachytherapy; D002637:Chest Pain / Q000209:etiology; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D023903:Coronary Restenosis / Q000175:diagnosis / Q000601:surgery; D004868:Equipment Failure / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000009:adverse effects; D053685:Laser Therapy; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis / Q000628:therapy; D012008:Recurrence; D012086:Reoperation; D012501:Saphenous Vein / Q000601:surgery; D020521:Stroke / Q000209:etiology / Q000517:prevention & control