Evaluation of a novel sutureless anastomotic connector: from endothelial function to mid-term clinical and angiographic follow-up.
OBJECTIVE
We evaluated the effect of the St Jude Medical sutureless anastomotic connector on endothelium-dependent and -independent saphenous vein graft relaxation, as well as on clinical outcomes and graft patency in patients.


METHODS
Human saphenous vein grafts were assigned to control or connector groups (loaded for 1 or 5 minutes; n = 18). Isometric dose-response curves to endothelium-dependent and -independent (sodium nitroprusside) vasodilators were constructed in saphenous vein grafts precontracted with phenylephrine. Thrombin-mediated vasorelaxation, an early determinant of saphenous vein graft failure, was also evaluated. Percent maximum relaxation was compared between groups. Patients in whom the St Jude Medical connector was employed underwent clinical follow-up, stress tests, and angiography 6 to 12 months postoperatively.


RESULTS
A23187-induced endothelium-mediated relaxation, sodium nitroprusside-induced endothelium-independent relaxation, and thrombin-mediated vasorelaxation did not differ between control and connector saphenous vein grafts at either time point studied. Twenty-seven patients received St Jude Medical connectors. There was no hospital mortality; patients were followed for 679 +/- 241 days. There was 1 late death; the connector saphenous vein graft was patent at postmortem. All connector saphenous vein grafts were patent at follow-up angiography. Four grafts had stenoses (30%-60%), without symptoms or requirement for intervention. All hand-sewn saphenous vein grafts were also patent.


CONCLUSIONS
The St Jude Medical connector does not impair endothelium-dependent vasorelaxation. In patients, patency of the connector saphenous vein grafts 6 to 12 months postoperatively was 100% but 22% of grafts had non-flow-limiting stenoses at or near the connector. Further long-term studies are required to confirm the safety of the St Jude Medical connector with regards to endothelial function and restenosis.
Verma
Subodh
S
Division of Cardiovascular Surgery, Toronto General Hospital, University Health Network, Department of Surgery, University of Toronto, Ontario, Canada.
Fedak
Paul W M
PW
Ko
Lawrence
L
Cusimano
Robert J
RJ
Walton
Nancy A
NA
Parker
John D
JD
Yau
Terrence M
TM
D000714:Anastomosis, Surgical / Q000295:instrumentation / Q000379:methods; D016022:Case-Control Studies; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000295:instrumentation* / Q000379:methods; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000601:surgery; D003331:Coronary Vessels / Q000473:pathology / Q000502:physiology; D004730:Endothelium, Vascular / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000453:epidemiology; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D008297:Male; D009599:Nitroprusside / Q000494:pharmacology; D012501:Saphenous Vein / Q000601:surgery / Q000637:transplantation*; D012680:Sensitivity and Specificity; D013536:Suture Techniques; D020858:Tissue and Organ Harvesting; D014654:Vascular Patency / Q000502:physiology*; D014664:Vasodilation
D009599:Nitroprusside