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Published on: December 11, 2017
Outcomes of 881 Consecutive Coronary Artery Bypass Graft Patients Using Heartstring Device
Kentaro Amano1, Yoshiyuki Takami1, Atsuo Maekawa1
1Department of Cardiovascular Surgery, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
Insights
Using the Heartstring device for coronary artery bypass grafting (CABG) is a valid strategy to prevent stroke. This method demonstrated a low perioperative stroke rate of 0.9%, contributing to improved long-term patient prognosis.
Area of Science:
- Cardiovascular Surgery
- Neurosurgery
- Medical Devices
Background:
- Stroke is a significant risk following coronary artery bypass grafting (CABG).
- Minimally invasive aortic manipulation techniques are sought to reduce perioperative complications.
- The Heartstring device offers a method for proximal anastomosis without aortic clamping.
Purpose of the Study:
- To evaluate the early and late outcomes of isolated CABG using the Heartstring device.
- To determine the validity and safety of the Heartstring device in preventing stroke during CABG.
- To assess the impact of this technique on long-term prognosis.
Main Methods:
- Retrospective investigation of 881 consecutive patients undergoing isolated CABG with the Heartstring device (January 2008 - December 2022).
- Preoperative imaging to assess neurovascular atherosclerosis in all patients.
- Analysis of early outcomes (in-hospital mortality, perioperative stroke) and late outcomes (survival, MACCEs).
Main Results:
- The study included 881 patients with a mean age of 68.9 years; 20% were female, and 13% had a prior stroke history.
- In-hospital mortality was 2.0%, and the perioperative stroke rate was 0.9%.
- At 5 and 10 years, actuarial survival rates were 86% and 66%, respectively. Major adverse cardiac and cerebrovascular events (MACCEs)-free rates were 86% and 70% at 5 and 10 years.
Conclusions:
- The Heartstring device for proximal anastomosis during CABG is associated with a low stroke rate (0.9%).
- This technique may contribute to improved long-term survival and reduced MACCEs after CABG.
- The findings support the validity of using the Heartstring device to mitigate stroke risk in CABG patients.
Backgrounds:
One of the strategies to prevent stroke after coronary artery bypass grafting (CABG) may be the use of a device for proximal anastomosis without partial clamp of the ascending aorta.
Methods:
We retrospectively investigated early and late outcomes in consecutive 881 patients undergoing isolated CABG using Heartstring for proximal anastomosis from January 2008 to December 2022, to reveal the validity to use it. All patients underwent preoperative imaging workups to evaluate neurovascular atherosclerosis.
Results:
The mean age of the patients was 68.9 years, 20% were female and 13% had previous history of stroke. CABG was on-pump beating heart (52.2%) or off-pump (47.8%) with a mean number of distal anastomoses of 3.38 ± 0.93, using 1.62 ± 0.53 Heartstring devices under different aortic manipulations. In-hospital mortality was 2.0% and perioperative stroke rate was 0.9%, none of them died during hospital stay. During the follow-up period of 70 ± 47 months, the overall actuarial survival rates were 86 and 66%, and major adverse cardiac and cerebrovascular events (MACCEs)-free rates were 86 and 70% at 5 and 10 years, respectively. On multivariable analysis, risk factors for late death included male, previous history of stroke, postoperative sternomediastinitis, late new-onset stroke, and MACCEs, but did not include the perioperative stroke.
Conclusion:
Low stroke rate, as low as 0.9%, after CABG using Heartstring for proximal anastomosis, although under a variety of aortic manipulations, may contribute to the improved long-term prognosis.
