title: Early clinical results of St. Jude Medical Symmetry aortic connector.
abstract: An automated anastomosis device named St. Jude Medical symmetry aortic connector has been used worldwide for off-pump coronary artery bypass grafting. However, early graft obstruction was recently reported, and its predictors should be clarified. From April 2002 to March 2004, 38 patients in our institution underwent off-pump coronary artery bypass grafting using the St. Jude Medical Symmetry aortic connector for saphenous vein graft (SVG) procedures; measurement of intraoperative graft flow and postoperative coronary angiography was performed. Early SVG events occurred in 9 (24%) patients: 8 occlusion cases and 1 case of stenosis. Predictors of early SVG events were assessed from a comparative study. Univariate logistic regression identified hyperlipidemia as the only significant predictor of early SVG events (P = 0.02, odds ratio 7.78). Lower SVG flow rate and poor ejection fraction did not show statistical significance (P = 0.09, odds ratio 1.09 and P = 0.09, odds ratio 0.96). The SVG event rate was much higher for the left circumflex branch compared with other locations (31% vs. 9%, P = 0.03) and decreased with increasing aortic connector size (small, 32%; median, 14%; large, 0%). Multivariate analysis did not identify a predictor of SVG events. The aortic connector is associated with a high incidence of early SVG events. Patients should be cautiously selected and the procedure should not be used for left anterior descending coronary artery or culprit lesions.
authors.affiliation: Department of Cardiothoracic Surgery, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya 466-8550, Japan. machapon@med.nagoya-u.ac.jp
authors.forename: Masashi
authors.initials: M
authors.lastname: Toyama
authors.forename: Akihiko
authors.initials: A
authors.lastname: Usui
authors.forename: Tomonobu
authors.initials: T
authors.lastname: Abe
authors.forename: Masaharu
authors.initials: M
authors.lastname: Yoshikawa
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Akita
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Ueda
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D000714:Anastomosis, Surgical / Q000295:instrumentation / Q000379:methods; D001011:Aorta / Q000601:surgery*; D047549:Coronary Artery Bypass, Off-Pump; D004867:Equipment Design; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012501:Saphenous Vein / Q000637:transplantation*; D014654:Vascular Patency