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Avoidance of aortic side-clamping for proximal bypass anastomoses: better short-term outcome?
Markus J Wilhelm1, Thomas Syburra, Lukas Furrer
1Clinic for Cardiac Surgery, City Hospital Triemli Zurich, Zurich, Switzerland. markus.wilhelm@usz.ch
Insights
Off-pump coronary artery bypass (OPCAB) surgery using the Heartstring device for proximal anastomoses significantly reduces stroke risk. This clampless technique demonstrates excellent short-term graft patency and safety in OPCAB procedures.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Procedures
Background:
- Aortic side-clamping during coronary artery bypass grafting can lead to microemboli and stroke.
- The Heartstring device offers an alternative for constructing proximal anastomoses without aortic clamping.
Purpose of the Study:
- To evaluate the safety and efficacy of the Heartstring device for clampless proximal anastomoses in off-pump coronary artery bypass (OPCAB) surgery.
- To assess the incidence of stroke and other adverse events associated with this technique.
Main Methods:
- Retrospective analysis of 260 consecutive patients undergoing OPCAB surgery.
- 442 proximal anastomoses performed using the Heartstring device.
- Coronary angiography performed on a random sample of patients to assess graft patency.
Main Results:
- Low incidence of stroke (0.8%) and early mortality (1.5%).
- No device-related bleeding or aortic dissection reported.
- 100% patency rate observed in Heartstring-assisted anastomoses at short-term follow-up.
Conclusions:
- Clampless proximal anastomoses with the Heartstring device in OPCAB surgery are associated with a low stroke complication rate.
- The technique shows excellent short-term results for bypass patency and safety.
- Further prospective randomized trials are needed to confirm the benefits of this approach.
Objectives:
The benefit of off-pump coronary artery bypass (OPCAB) surgery may be reduced by strokes caused by microemboli produced after aortic side-clamping for proximal bypass anastomoses. The Heartstring device allows constructing proximal bypass anastomoses without side-clamping of the aorta.
Methods:
This retrospective study describes 260 consecutive patients who underwent OPCAB surgery; 442 proximal anastomoses were performed with the Heartstring device in this series. Ten percent of the patients were randomly sampled before discharge to undergo a coronary angiogram for assessment of graft patency.
Results:
Intraoperative Doppler measurements confirmed regular bypass function. Early mortality occurred in 4 patients (1.5%), and stroke occurred in 2 patients (0.8%). Device-related bleeding was negligible, and there were no cases of aortic dissection. Perioperative ischemia occurred in 8 patients (3.1%). Predischarge coronary angiography evaluations in 25 of the patients (of 260) showed that all 42 Heartstring-assisted anastomoses (of 442) were patent.
Conclusions:
Clampless performance of proximal bypass anastomoses combined with OPCAB is associated with a very low incidence of stroke complications. Short-term follow-up has shown excellent results regarding bypass patency and other adverse events. Prospective randomized trials are required to confirm the advantage of this technique.
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