title: Initial clinical experience with the Heartstring.
abstract: OBJECTIVE
  The Heartstring is one of the devices that enable proximal anastomosis without clamping the aorta. We have applied the device not only to low-risk patients with normal aortas but also to high-risk patients with diseased aortas. The purpose of this study was to investigate the initial outcomes of using this device.
  
  
  METHODS
  The Heartstring was used on 87 patients between January and December 2004. The patients comprised 62 men and 25 women 48-86 years old (mean 68.4 +/- 8.4 years). The ascending aorta was evaluated by computed tomography (CT) scanning before surgery. If a patient's aorta was severely calcified, epiaortic echocardiography was performed. The aortas were ranked into four grades, and the preoperative patient's status were evaluated by the EuroSCORE. Angiography was performed on the third postoperative day.
  
  
  RESULTS
  CT scanning revealed that 74 patients had no calcification in the ascending aorta, 10 patients had scattered calcification, and 3 patients had plate-like calcification. The EuroSCORE was 6.86 +/- 1.03. We performed 93 proximal anastomoses and 149 distal anastomoses. The average distal anastomosis was 1.6 +/- 0.6 sites per graft. Of the distal anastomoses, 74.2% were to the circumflex artery territory. Postoperative coronary angiography revealed that all grafts were patent.
  
  
  CONCLUSIONS
  The Heartstring facilitates safe proximal anastomosis, even in high-risk patients. Their short-term outcome was good. The device assists in bypassing circumflex artery territory. Long-term follow-up is necessary.
authors.affiliation: Department of Cardiovascular Surgery, Cardiovascular Center, Hokkaido Ohno Hospital, 4-1-1-30 Nishino Nishi-ku, Sapporo, Hokkaido 063-0034, Japan. t-kazui@pf6.so-net.ne.jp
authors.forename: Toshinobu
authors.initials: T
authors.lastname: Kazui
authors.forename: Hirosato
authors.initials: H
authors.lastname: Doi
authors.forename: Masato
authors.initials: M
authors.lastname: Suzuki
authors.forename: Takashi
authors.initials: T
authors.lastname: Okamoto
authors.forename: Ryuji
authors.initials: R
authors.lastname: Koshima
authors.forename: Kenji
authors.initials: K
authors.lastname: Sugiki
authors.forename: Takemi
authors.initials: T
authors.lastname: Ohno
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000295:instrumentation*; D001011:Aorta / Q000601:surgery*; D001026:Coronary Artery Bypass / Q000295:instrumentation*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000601:surgery; D016896:Treatment Outcome