title: Initial experience with sutureless proximal anastomoses performed with a mechanical connector leading to clampless off-pump coronary artery bypass surgery.
abstract: BACKGROUND
  We report our early experience with the Symmetry Aortic Connector (St. Jude Medical, St. Paul, MN) used for sutureless proximal aortosaphenous vein graft anastomoses without any cross clamp during coronary bypass procedures.
  
  
  METHODS
  Between November 2001 and August 2002, 206 saphenous vein to aorta proximal anastomoses were created in 132 patients using the Symmetry device. All procedures were performed as part of off-pump coronary artery bypass surgery without any aortic clamping. Intraoperative variables and postoperative data were collected and analyzed retrospectively.
  
  
  RESULTS
  All 206 anastomoses (100%) were successfully completed with the connector. Severe atherosclerotic disease of the aorta was documented in 16 patients (12%). Four anastomoses (2%) required additional suture placement. Predeployment problems occurred with 3 grafts (2.5%) during loading of the connector. Average number of distal bypasses was 3.2 per patient. One patient (0.7%) required reoperation for bleeding from a proximal anastomosis. Six patients (4.5%) had perioperative myocardial infarction documented by electrocardiographic changes. Thirty-day operative mortality was 3% (4 patients). Intraoperative transit time flow measurement was performed in all cases (100%). Postoperative angiography in 43 patients at a median 3 months postoperatively revealed occlusion of 9 of the 81 saphenous vein grafts (11%).
  
  
  CONCLUSIONS
  The initial experience with a proximal saphenous vein graft to aorta anastomosis using the Symmetry connector demonstrates safety and ease of use. There is however some concern with early graft closure. A prospective randomized study is needed to clarify these concerns.
authors.affiliation: Division of Cardiothoracic Surgery, University of Miami/Jackson Memorial Hospital, Miami, Florida, USA. kkatariya@med.miami.edu
authors.forename: Kushagra
authors.initials: K
authors.lastname: Katariya
authors.forename: Said
authors.initials: S
authors.lastname: Yassin
authors.forename: Hassan Y
authors.initials: HY
authors.lastname: Tehrani
authors.forename: Pierluca
authors.initials: P
authors.lastname: Lombardi
authors.forename: Saqib
authors.initials: S
authors.lastname: Masroor
authors.forename: Tomas A
authors.initials: TA
authors.lastname: Salerno
mesh_terms: D000368:Aged; D000497:Alloys; D000714:Anastomosis, Surgical / Q000295:instrumentation*; D001013:Aorta, Thoracic / Q000601:surgery; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000295:instrumentation*; D004867:Equipment Design; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D015607:Stents; D013525:Surgical Instruments; D013536:Suture Techniques / Q000295:instrumentation*; D014680:Veins / Q000637:transplantation
chemical_list: D000497:Alloys; C013616:nitinol