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Further…the future ain’t what it used to be.

April 9, 2007

Coronary artery bypass CBG surgery with devices for facilitated

anastomosis – harpoon hooks holding or missing the mark?

How well can standard suturing techniques (using running polypropylene

material) be replaced by mechanical and automated anastomosis?
What are the needs of a technique of minimally invasive delivery of an
implanted device? How could we simplify the proximal anastomosis of an
aortic autologous vein graft?

Fig 2: The PAS-PortTM System exists in one size and is compatible with vein grafts from
4–6 mm outer diameter and aortas with more than 18 mm outer diameter.
A fallen star, the Symmetry TM Aortic Connector System, from St. Jude
Medical has connectors that are made of nitinol memory alloy and come
in sizes according to the vein graft diameter. A transfer sheet facilitates
the loading process of sliding the vein on the release tube where the
adventitia is removed from the end of the vein. Once loaded on the
delivery system the hooks of the connector penetrate the wall of the vein
and hold on. The Aortic Connector system uses a unique rotating blade
that greatly facilitates application: the total delivery of the device takes
less than 10 s under a mean arterial pressure of around 50–60 mm Hg over
systolic not over 100 mm Hg. Unfortunately acute thrombosis of the aortic
ostia has been reported with the St. Jude connector use.

But can the device avoid neither having to create the neo-ostium nor
delivering the fixation device with the help of tangential clamping of the
aorta? How can a perfectly round hole created without damaging the
adjacent aortic walls?
Fig. 4: Loading of the vein on the aortic connector and its delivery to the aorta, St Jude Medical
Anastomotic Technology Group (Minneapolis, Minn).

The needs for surgical maneuvers on the beating heart within confined
spaces are currently been revisited. Focus is on facilitating OPCAB and
endoscopic CABG through direct manipulation and without any
clamping of the aorta. A future system may allow the physician the
creation of reliable, reproducible, and steady automated anastomosis.

K.T.

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