title: Hand-Sewn Proximal Anastomoses in Off-Pump Coronary Artery Bypass Without the Need for Partial Occlusion Clamping: Experience With the Heartstring II Proximal Seal System.
abstract: OBJECTIVE
  : To evaluate the use of the Heartstring II Proximal Seal System (HPSS) in saphenous vein to aorta anastomoses in off-pump coronary artery bypass (OPCAB).
  
  
  METHODS
  : The HPSS consists of an aortic cutter and a proximal seal system. A prospective study was done using the HPSS to facilitate proximal hand-sewn anastomoses in OPCAB without partial occlusion clamping. Intraoperative observations, including technical success and post operative clinical data, were recorded.
  
  
  RESULTS
  : Using the HPSS, 84 hand-sewn proximal saphenous vein-to-aorta anastomoses were done in 50 patients. In no case was conversion to partial occlusion clamping required. After deployment of the HPSS, operator evaluation showed acceptable hemostasis in 83 of the grafts. One graft required redeployment of a second HPSS. Each bypass graft was evaluated using the Medtronic Medistem Flow Probe. Acceptable flow probe values were present in all grafts, and no revisions were required. The mean length of time for completion of the proximal anastomosis was 5 minutes (range, 4 to 14 minutes). Postoperative clinical evaluation showed no adverse events attributed to the use of the HPSS.
  
  
  CONCLUSIONS
  : The use of HPSS is a safe and effective method to avoid partial occlusion clamping in hand-sewn proximal anastomoses with OPCAB.
authors.affiliation: From the *Division of Thoracic and Cardiovascular Surgery, University of Tennessee Health Science Center, Memphis, Tennessee; †Methodist Healthcare, Memphis Hospitals, Memphis, Tennessee; and ‡Methodist Healthcare Foundation, Memphis, Tennessee.
authors.forename: Glenn Phillip
authors.initials: GP
authors.lastname: Schoettle
authors.forename: Carol Basham
authors.initials: CB
authors.lastname: Jones