Ultrafast computed tomography for quality control of automated proximal anastomoses

The Symmetry aortic connector uses a nitinol implant to create proximal anastomoses with saphenous vein grafts. Multiple detector-row cardiac computed tomography (MDCT) is used as a noninvasive method of quality control at our institution.

In 50 elective coronary artery bypass grafting patients who participated in a randomized trial comparing automated with conventionally hand-sewn proximal anastomoses, MDC T was performed on postoperative day 5. Fifty-three automated Symmetry anastomoses were created in 34 patients (group 1). Twenty-five conventionally hand-sewn anastomoses created in 16 patients served as controls (group 2). Graft patency and the presence or absence of high-grade stenosis at the proximal anastomotic site were evaluated.

In group 1, 2 (3.8%) of the grafts were found occluded at MDCT or coronary angiography, and no further relevant stenosis was observed. In group 2, at postoperative MDCT all grafts were found patent without significant narrowing of the proximal anastomotic site.

The feasibility of proximal anastomoses using the Symmetry device has been reported. Patency control with invasive angiography has been performed by other groups. With MDCT, noninvasive evaluation of proximal anastomotic quality and graft patency is possible, even if nitinol is implanted.