Ultrafast computed tomography for quality control of automated proximal anastomoses.
BACKGROUND
The Symmetry aortic connector uses a nitinol implant to create proximal anastomoses with saphenous vein grafts. Multiple detector-row cardiac computed tomography (MDCT) is used as a noninvasive method of quality control at our institution.


METHODS
In 50 elective coronary artery bypass grafting patients who participated in a randomized trial comparing automated with conventionally hand-sewn proximal anastomoses, MDC T was performed on postoperative day 5. Fifty-three automated Symmetry anastomoses were created in 34 patients (group 1). Twenty-five conventionally hand-sewn anastomoses created in 16 patients served as controls (group 2). Graft patency and the presence or absence of high-grade stenosis at the proximal anastomotic site were evaluated.


RESULTS
In group 1, 2 (3.8%) of the grafts were found occluded at MDCT or coronary angiography, and no further relevant stenosis was observed. In group 2, at postoperative MDCT all grafts were found patent without significant narrowing of the proximal anastomotic site.


CONCLUSIONS
The feasibility of proximal anastomoses using the Symmetry device has been reported. Patency control with invasive angiography has been performed by other groups. With MDCT, noninvasive evaluation of proximal anastomotic quality and graft patency is possible, even if nitinol is implanted.
Martens
Sven
S
Department of Thoracic and Cardiovascular Surgery, University Hospital J. W. Goethe, Frankfurt, Germany. martens.herz@gmx.de
Herzog
Christopher
C
Dietrich
Markus
M
Doss
Mirko
M
Wimmer-Greinecker
Gerhard
G
Moritz
Anton
A
D000368:Aged; D000497:Alloys / Q000627:therapeutic use*; D000714:Anastomosis, Surgical / Q000295:instrumentation / Q000379:methods / Q000592:standards; D001026:Coronary Artery Bypass / Q000379:methods* / Q000592:standards; D005240:Feasibility Studies; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D011786:Quality Control; D013536:Suture Techniques; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014654:Vascular Patency
D000497:Alloys; C013616:nitinol