Aortic spoon-jaw clamp for aorto-saphenous vein anastomosis

In the course of coronary bypass operations the proximal anastomosis of the saphenous vein to the aorta is commonly done either with the aorta clamped completely or by using a partially occluding clamp. While under usual circumstances, either method is feasible; under other conditions, such as in the presence of partial calcification, heavy atherosclerotic deposits, or in reoperations, it is preferable not to perform either of the above methods. The purpose of this article is to present an instrument designed to allow performance of the proximal anastomosis without application of any aortic clamping in the following manner. A relatively healthy spot on the ascending aorta is selected. Under protection of a mattress suture, a stab wound is made on the aortic wall, and the lower jaw of the instrument is inserted through it into the aortic lumen. A spot is selected for the anastomotic site, the instrument is placed to that area, and its handle is closed. This effectively isolates a 10 x 8 mm area of the aortic wall from the blood flow. An opening is made in the area protected by the clamp. With the jaws of the clamp closed the vein-to-aorta anastomosis is completed as usual.