title: Cerebral microembolization during off-pump coronary artery bypass surgery with the Symmetry aortic connector device.
abstract: OBJECTIVE
  The use of aortic connector systems for proximal vein grafts in off-pump coronary artery bypass grafting might minimize aortic manipulation by eliminating the need for partial aortic clamping. The objective of this study was to asses whether use of a Symmetry connector (St Jude Medical, Inc, St Paul, Minn) reduced intraoperative cerebral embolization.
  
  
  METHODS
  Thirty-two consecutive patients underwent off-pump coronary artery bypass grafting. Sixteen patients received at least one mechanical proximal vein graft anastomosis with a Symmetry aortic connector system. Sixteen patients representing the control group underwent operations with standard suturing techniques using partial aortic clamping. During surgical intervention, all patients were monitored continuously with multifrequency transcranial Doppler scanning, which detected and differentiated cerebral emboli.
  
  
  RESULTS
  There were significantly more cerebral emboli in the Symmetry group (median, 36) compared with the control group (median, 11; P = .027). This was due to a higher number of gaseous emboli in the Symmetry group than in the control group (median, 27 vs 8; P = .014), whereas there was no significant difference regarding the number of solid emboli (median, 7 vs 3; P = .139).
  
  
  CONCLUSIONS
  Use of a Symmetry connector system during proximal vein graft anastomosis increased the number of emboli to the brain compared with a standard technique in coronary bypass surgery without cardiopulmonary bypass.
authors.affiliation: Department of Neurology, Rikshospitalet University Hospital, Oslo, Norway. mona.skjelland@rikshospitalet.no
authors.forename: Mona
authors.initials: M
authors.lastname: Skjelland
authors.forename: Jacob
authors.initials: J
authors.lastname: Bergsland
authors.forename: Runar
authors.initials: R
authors.lastname: Lundblad
authors.forename: Per Snorre
authors.initials: PS
authors.lastname: Lingaas
authors.forename: Kjell Arne
authors.initials: KA
authors.lastname: Rein
authors.forename: Steinar
authors.initials: S
authors.lastname: Halvorsen
authors.forename: Jan L
authors.initials: JL
authors.lastname: Svennevig
authors.forename: Erik
authors.initials: E
authors.lastname: Fosse
authors.forename: Rainer
authors.initials: R
authors.lastname: Brucher
authors.forename: David
authors.initials: D
authors.lastname: Russell
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic; D047549:Coronary Artery Bypass, Off-Pump / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D006801:Humans; D020766:Intracranial Embolism / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D017585:Ultrasonography, Doppler, Transcranial