title: A systematic review of the safety and efficacy of distal coronary artery anastomotic devices in MIDCAB and TECAB surgery.
abstract: BACKGROUND
  Minimally invasive direct coronary artery bypass (MIDCAB) and totally endoscopic coronary artery bypass (TECAB) techniques may improve recovery and reduce hospital stay following coronary artery bypass surgery (CABG). However, working in a limited space with indirect visualisation would greatly benefit from a simple, high-quality and reproducible automated distal anastomotic method. Several devices have been developed; however, their uptake has been limited due to uncertainty around their impact on patient outcomes.
  
  
  METHODS
  A systematic review of the literature identified six studies, incorporating 139 subjects undergoing MIDCAB or TECAB surgery using a distal anastomotic device.
  
  
  RESULTS
  The overall 30-day mortality was 0.7% (1/137). No cardiac specific mortality was observed. For each outcome of perioperative myocardial infarction (MI), postoperative stroke and haemorrhage, only a single event was observed for each (n=1/136, 1/138 and 1/136, respectively). The overall device failure rates were low, with the use of additional sutures only reported in a single case with the Magnetic Vascular Port (MVP) device. Anastomotic time ranged from a mean of 3.32 minutes with the MVP device to 20 minutes with the C-Port device.
  
  
  CONCLUSIONS
  These results demonstrate the overall acceptable early outcomes of distal anastomotic devices for use in minimally invasive coronary bypass surgery. Future research should focus on designing adequately powered, comparative, randomised trials, focusing on major adverse cardiac and cerebrovascular events (MACCE) outcomes in both the short and long-term, with clear case-by-case reasons for device failure and a comparison of anastomotic times. In this way, we may determine whether such devices will facilitate the minimal access and robotic coronary procedures of the future.
authors.affiliation: Department of Surgery and Cancer, Imperial College London, UK.
authors.forename: Erdinc
authors.initials: E
authors.lastname: Soylu
authors.affiliation: Department of Surgery and Cancer, Imperial College London, UK Leanne.harling@imperial.ac.uk.
authors.forename: Leanne
authors.initials: L
authors.lastname: Harling
authors.affiliation: Department of Surgery and Cancer, Imperial College London, UK.
authors.forename: Hutan
authors.initials: H
authors.lastname: Ashrafian
authors.affiliation: Department of Surgery and Cancer, Imperial College London, UK.
authors.forename: Saina
authors.initials: S
authors.lastname: Attaran
authors.affiliation: Department of Surgery and Cancer, Imperial College London, UK.
authors.forename: Christina
authors.initials: C
authors.lastname: Athanasiou
authors.affiliation: Department of Surgery and Cancer, Imperial College London, UK.
authors.forename: Prakash P
authors.initials: PP
authors.lastname: Punjabi
authors.affiliation: Department of Surgery and Cancer, Imperial College London, UK.
authors.forename: Roberto
authors.initials: R
authors.lastname: Casula
authors.affiliation: Department of Surgery and Cancer, Imperial College London, UK.
authors.forename: Thanos
authors.initials: T
authors.lastname: Athanasiou
mesh_terms: D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D003331:Coronary Vessels / Q000601:surgery*; D004724:Endoscopy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D004868:Equipment Failure; D006801:Humans; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome
keywords: MIDCAB; TECAB; anastomotic device; bypass; coronary; off-pump