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Results with the Heartstring anastomotic device in patients with diseased ascending aorta
Fausto Biancari1, Martti Mosorin, Jarmo Lahtinen
1Division of Cardio-Thoracic and Vascular Surgery, Department of Surgery, Oulu University Hospital, Oulu, Finland. faustobiancari@yahoo.it
Insights
The Heartstring device facilitates aortic anastomosis during off-pump coronary artery bypass surgery, reducing stroke risk in patients with diseased aortas. This technique is a viable option for high-risk individuals needing prompt myocardial revascularization.
Area of Science:
- Cardiovascular Surgery
- Medical Devices
- Aortic Surgery
Background:
- Diseased ascending aorta manipulation increases stroke risk after off-pump coronary artery bypass surgery (OPCAB).
- The Heartstring device offers an alternative for proximal aortic anastomosis without aortic clamping in OPCAB.
Purpose of the Study:
- To evaluate the efficacy and safety of the Heartstring device for proximal aortic anastomosis in patients undergoing OPCAB with a diseased ascending aorta.
Main Methods:
- The Heartstring device was used for proximal aortic anastomoses in 19 patients undergoing OPCAB with calcified ascending aorta.
- Intraoperative epiaortic ultrasound scanning diagnosed the diseased ascending aorta.
Main Results:
- Successful anastomoses were achieved in 18 vein grafts and 3 radial artery grafts using the Heartstring device.
- Eight seal breakages occurred during device insertion.
- One patient (5.2%) experienced a stroke postoperatively.
Conclusions:
- The Heartstring anastomotic device is a potential option for high-risk patients with diseased ascending aorta requiring urgent myocardial revascularization.
- Safe insertion of the device into the ascending aorta is crucial for its successful application.
Background:
Avoidance of manipulation of diseased ascending aorta has been shown to be associated with a reduced risk of postoperative stroke after off-pump coronary artery bypass surgery (OPCAB). The use of the Heartstring device (Guidant, Indianapolis, USA) to accomplish a proximal aortic anastomosis without aortic clamping has been suggested in such patients.
Patients And Methods:
From April 2004 to December 2005, proximal aortic anastomoses have been accomplished employing the Heartstring device in 19 patients with calcified ascending aorta who underwent OPCAB. The diagnosis of diseased ascending aorta was made intraoperatively by epiaortic ultrasound scanning.
Results:
Eighteen vein grafts and three radial artery grafts have been successfully anastomosed to the ascending aorta by employing the Heartstring device. Breaking of eight seals occurred during insertion. One patient (5.2%) had stroke two days after urgent OPCAB.
Conclusion:
The use of the Heartstring anastomotic device should be considered in high-risk patients with diseased ascending aorta requiring a prompt myocardial revascularization, whenever there is a place to safely insert this device into the ascending aorta.
