Redo-OPCAB via left thoracotomy using symmetry aortic connector system: a report of two cases
Saqib Masroor1, Kushagra Katariya, Said Yassin
1Division of Thoracic and Cardiovascular Surgery, University of Miami/Jackson Memorial Hospital, Miami, Florida 33132, USA.
Insights
This study demonstrates the successful use of the Symmetry aortic connector system for proximal anastomoses in redo off-pump coronary artery bypass grafting (OPCAB). This technique offers a viable alternative for patients with heavily calcified aortas, simplifying the procedure.
Area of Science:
- Cardiovascular Surgery
- Medical Device Technology
Background:
- Left thoracotomy is a standard approach for redo coronary artery bypass grafting (CABG), including off-pump coronary artery bypass (OPCAB).
- Traditionally, proximal anastomoses are made to the descending thoracic aorta or left subclavian artery.
- Newer proximal connectors, like the Symmetry aortic connector system, are available for use on the ascending aorta in primary and OPCAB procedures.
Observation:
- The Symmetry aortic connector system was successfully employed in two patients undergoing redo-OPCAB.
- Proximal anastomoses were constructed on the descending aorta using this device.
- This approach allowed for the use of shorter vein grafts due to the proximity of the descending aorta.
Findings:
- The Symmetry aortic connector system facilitates proximal anastomoses on the descending aorta during redo-OPCAB.
- The use of this device bypasses the need for partial occluding clamps, which is advantageous in cases of heavily calcified aortas.
- Employing the descending aorta for anastomosis can conserve limited vein graft availability in redo procedures.
Implications:
- The Symmetry aortic connector system provides a safe and effective option for complex redo-OPCAB surgeries, particularly in patients with aortic calcification.
- This technique may improve outcomes in redo-CABG by simplifying anastomosis and potentially preserving graft length.
- Further research could explore the long-term efficacy and broader application of this device in various bypass grafting scenarios.
Abstract:
Left thoracotomy is an established approach for redo coronary artery bypass grafting (CABG). This approach has also been successfully used in off-pump coronary artery bypass (OPCAB). Traditionally, the grafts have been anastomosed proximally to the descending thoracic aorta or the left subclavian artery. Recently, proximal connectors have been introduced by various manufacturers for use on ascending aorta during primary CABG and OPCAB. One such device is the Symmetry aortic connector system (St. Jude Medical, Minneapolis, MN). These devices have obviated the need for partial occluding clamps for the construction of the proximal anastomoses and hence are extremely useful when the aorta is heavily calcified. We used this device successfully in two patients undergoing redo-OPCAB, where the proximal anastomosis was constructed on the descending aorta. In so doing, we also used the shortest possible length of vein graft since the descending aorta at that level was much closer than the left subclavian artery. This can be an additional factor in redo-operations where the availability of vein can be an issue.
