Results with the Heartstring anastomotic device in patients with diseased ascending aorta.
BACKGROUND
Avoidance of manipulation of diseased ascending aorta has been shown to be associated with a reduced risk of postoperative stroke after off-pump coronary artery bypass surgery (OPCAB). The use of the Heartstring device (Guidant, Indianapolis, USA) to accomplish a proximal aortic anastomosis without aortic clamping has been suggested in such patients.


METHODS
From April 2004 to December 2005, proximal aortic anastomoses have been accomplished employing the Heartstring device in 19 patients with calcified ascending aorta who underwent OPCAB. The diagnosis of diseased ascending aorta was made intraoperatively by epiaortic ultrasound scanning.


RESULTS
Eighteen vein grafts and three radial artery grafts have been successfully anastomosed to the ascending aorta by employing the Heartstring device. Breaking of eight seals occurred during insertion. One patient (5.2%) had stroke two days after urgent OPCAB.


CONCLUSIONS
The use of the Heartstring anastomotic device should be considered in high-risk patients with diseased ascending aorta requiring a prompt myocardial revascularization, whenever there is a place to safely insert this device into the ascending aorta.
Biancari
Fausto
F
Division of Cardio-Thoracic and Vascular Surgery, Department of Surgery, Oulu University Hospital, Oulu, Finland. faustobiancari@yahoo.it
Mosorin
Martti
M
Lahtinen
Jarmo
J
Heikkinen
Jouni
J
Rasinaho
Elsi
E
Anttila
Vesa
V
Lepojärvi
Martti
M
Juvonen
Tatu
T
D000368:Aged; D000714:Anastomosis, Surgical / Q000295:instrumentation*; D001011:Aorta / Q000601:surgery; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D047549:Coronary Artery Bypass, Off-Pump / Q000295:instrumentation*; D005260:Female; D006801:Humans; D011183:Postoperative Complications / Q000517:prevention & control; D020521:Stroke / Q000517:prevention & control; D014463:Ultrasonography; D014656:Vascular Surgical Procedures / Q000295:instrumentation