title: First-year outcomes of beating heart coronary artery bypass grafting using proximal mechanical connectors.
abstract: BACKGROUND
  To determine the extended results of mechanical connectors we compared the 1-year outcomes of patients having beating heart coronary artery bypass surgery with at least one sutured or mechanically connected proximal vein graft anastomosis.
  
  
  METHODS
  From May 2001 to December 2001, 166 patients were identified as having undergone off-pump bypass grafting utilizing at least one St. Jude symmetry aortic connector (St Jude Medical Anastomotic Technology Group, St. Paul, MN). Follow-up for major adverse cardiac events (MACEs), which is defined as cardiac mortality, myocardial infarction, or revascularization of a previous target vessel, was obtained on 162 patients (97.6%). A control group of 159 patients was identified from a cohort of patients having beating heart surgery with one or more sutured proximal vein graft anastomosis in the preceding year. The MACE follow-ups were obtained in 136 patients (85.6%) by direct telephone contact.
  
  
  RESULTS
  Patients with connectors showed an accelerated number of MACEs beginning approximately 180 days from the time of surgery and stabilizing at approximately 300 days. Logistic regression analysis identified the presence of diabetes as a significant preoperative risk factor predisposing patients to earlier onset of MACEs (p = 0.03) with an odds ratio of 2.9 (95% confidence interval, 1.1 to 7.6). Insulin dependent diabetics showed no differences between connector and control patients in the frequency or timing of MACEs. Connector patients using oral hypoglycemic agents demonstrated a significant deviation (p = 0.01) from a similar control population in the prevalence and timing of MACEs.
  
  
  CONCLUSIONS
  Connector patients showed an increased incidence of early MACEs. These events were characterized by an increased requirement for early target vessel revascularization and were predominantly in noninsulin-dependent diabetics.
authors.affiliation: Cardiopulmonary Research Science and Technology Institute, Dallas, Texas 75230, USA. tdewey@csant.com
authors.forename: Todd M
authors.initials: TM
authors.lastname: Dewey
authors.forename: Katherine
authors.initials: K
authors.lastname: Crumrine
authors.forename: Morley A
authors.initials: MA
authors.lastname: Herbert
authors.forename: Allison
authors.initials: A
authors.lastname: Leonard
authors.forename: Syma L
authors.initials: SL
authors.lastname: Prince
authors.forename: Christina
authors.initials: C
authors.lastname: Worley
authors.forename: James R
authors.initials: JR
authors.lastname: Edgerton
authors.forename: Mitchell J
authors.initials: MJ
authors.lastname: Magee
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mack
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000295:instrumentation*; D001026:Coronary Artery Bypass / Q000295:instrumentation* / Q000379:methods; D003327:Coronary Disease / Q000601:surgery; D003925:Diabetic Angiopathies / Q000601:surgery; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019736:Prostheses and Implants; D012307:Risk Factors; D012501:Saphenous Vein / Q000637:transplantation; D013537:Sutures; D016896:Treatment Outcome