title: Avoidance of aortic side-clamping for proximal bypass anastomoses: better short-term outcome?
abstract: OBJECTIVE
  The benefit of off-pump coronary artery bypass (OPCAB) surgery may be reduced by strokes caused by microemboli produced after aortic side-clamping for proximal bypass anastomoses. The Heartstring device allows constructing proximal bypass anastomoses without side-clamping of the aorta.
  
  
  METHODS
  This retrospective study describes 260 consecutive patients who underwent OPCAB surgery; 442 proximal anastomoses were performed with the Heartstring device in this series. Ten percent of the patients were randomly sampled before discharge to undergo a coronary angiogram for assessment of graft patency.
  
  
  RESULTS
  Intraoperative Doppler measurements confirmed regular bypass function. Early mortality occurred in 4 patients (1.5%), and stroke occurred in 2 patients (0.8%). Device-related bleeding was negligible, and there were no cases of aortic dissection. Perioperative ischemia occurred in 8 patients (3.1%). Predischarge coronary angiography evaluations in 25 of the patients (of 260) showed that all 42 Heartstring-assisted anastomoses (of 442) were patent.
  
  
  CONCLUSIONS
  Clampless performance of proximal bypass anastomoses combined with OPCAB is associated with a very low incidence of stroke complications. Short-term follow-up has shown excellent results regarding bypass patency and other adverse events. Prospective randomized trials are required to confirm the advantage of this technique.
authors.affiliation: Clinic for Cardiac Surgery, City Hospital Triemli Zurich, Zurich, Switzerland. markus.wilhelm@usz.ch
authors.forename: Markus J
authors.initials: MJ
authors.lastname: Wilhelm
authors.forename: Thomas
authors.initials: T
authors.lastname: Syburra
authors.forename: Lukas
authors.initials: L
authors.lastname: Furrer
authors.forename: Jürgen
authors.initials: J
authors.lastname: Frielingsdorf
authors.forename: Dragan
authors.initials: D
authors.lastname: Odavic
authors.forename: Kirk
authors.initials: K
authors.lastname: Graves
authors.forename: Michele
authors.initials: M
authors.lastname: Genoni
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000295:instrumentation*; D001013:Aorta, Thoracic; D017023:Coronary Angiography; D047549:Coronary Artery Bypass, Off-Pump / Q000295:instrumentation*; D015150:Echocardiography, Doppler; D004867:Equipment Design; D004869:Equipment Safety; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D020521:Stroke / Q000209:etiology / Q000517:prevention & control; D015996:Survival Rate; D016896:Treatment Outcome