Decreased intermediate term patency of automated proximal anastomoses evaluated by sequential ultrafast CT.
OBJECTIVE
The Symmetrytrade mark aortic connector creates proximal anastomoses of saphenous vein grafts using a nitinol implant. The device avoids partial clamping and thus possibly reduces neurologic complications. To evaluate graft patency, a single surgeon randomised study was performed in our institution.


METHODS
Seventy-seven patients were randomised either to automated proximal anastomoses (group I, n=39, 61 vein grafts connected using the aortic connector, 47 as single, 15 as sequential bypasses) or controls (group II, n=38, 62 proximal anastomoses handsewn, 46 as single, 16 as sequential bypasses). Ultrafast CT-scans were performed on postoperative day 5 in 34 patients of group I and 16 patients of group II to evaluate early graft patency. Intermediate term patency was evaluated with ultrafast CT-scan in 30 patients of group I (46 grafts) and 25 patients of group II (39 grafts) 1 year after the operation.


RESULTS
Two early graft occlusions were detected in group I (3.8%). In group II all evaluated grafts were patent 5 days after surgery. 11.4 months after surgery, seven out of 46 grafts were found occluded (15.2%) in group I. In the control group, only one occlusion was detected (2.6%).


CONCLUSIONS
We observed a trend towards an increased occlusion rate 1 year after surgery with automated connector devices. For evaluation of long-term patency larger patient groups have to be evaluated. Other benefits of these devices have to be proven to promote their clinical application.
Dietrich
Markus
M
Department of Thoracic and Cardiovascular Surgery, JW Goethe University Clinic, Frankfurt, Germany. md.md@gmx.de
Martens
Sven
S
Kohlert
Melanie
M
Herzog
Christopher
C
Khan
Mohammad Fawad
MF
Wimmer-Greinecker
Gerhard
G
Moritz
Anton
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000295:instrumentation* / Q000379:methods; D001026:Coronary Artery Bypass / Q000379:methods*; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging*; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D012501:Saphenous Vein / Q000637:transplantation; D014057:Tomography, X-Ray Computed / Q000379:methods; D014654:Vascular Patency