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Automatic connector devices for proximal anastomoses do not decrease embolic debris compared with conventional

Sven Martens1, Markus Dietrich, Christopher Herzog

  • 1Department for Thoracic and Cardiovascular Surgery, University Hospital J.W. Goethe, Frankfurt 60590, Germany. martens.herz@gmx.de

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|May 18, 2004
PubMed
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Automated proximal anastomotic devices and intra-aortic filtration did not reduce particulate emboli during cardiac surgery compared to conventional methods. The anastomotic process itself, rather than clamping, appears to be a primary source of emboli.

Area of Science:

  • Cardiovascular Surgery
  • Biomaterials Engineering
  • Medical Device Technology

Background:

  • Cardiac surgery, particularly aortic manipulation, can generate emboli, leading to adverse outcomes.
  • Proximal anastomotic devices aim to reduce trauma by avoiding partial clamping.
  • Intra-aortic filtration is effective in capturing debris during procedures.

Purpose of the Study:

  • To compare particulate debris and clinical outcomes between automated proximal anastomoses using a device and conventional handsewn anastomoses.
  • To evaluate the efficacy of intra-aortic filtration in capturing emboli during these procedures.

Main Methods:

  • A prospective randomized study of 77 patients undergoing coronary artery bypass grafting.
  • Patients were assigned to either an anastomotic device group or a conventional handsewn anastomosis group.

Related Experiment Videos

  • Intra-aortic filters were used before and after proximal anastomosis to capture debris for analysis; clinical outcomes were monitored.

    • Main Results:

    • No significant difference in the amount of particulate debris captured by filters between the device and conventional groups.
    • A significant decrease in particulate debris was observed from the first to the second filter in both groups.
    • Clinical outcomes, including adverse events, neurocognitive function, graft patency, and mortality, showed no significant differences between groups.

    Conclusions:

    • Proximal aortic connectors without partial clamping do not reduce particulate emboli or improve clinical outcomes compared to conventional anastomoses.
    • Cross-clamping during cardiopulmonary bypass generates less particulate debris than proximal anastomoses performed off-pump.
    • The anastomotic process itself is a significant source of emboli in cardiac surgery.