Ultrafast Computed Tomography for Quality Control of Automated Proximal Anastomoses


  • Sven Martens
  • Christopher Herzog
  • Markus Dietrich
  • Mirko Doss
  • Gerhard Wimmer-Greinecker
  • Anton Moritz




Background: The Symmetry aortic connector uses a nitinol implant to create proximal anastomoses with saphenous vein grafts. Multiple detector-row cardiac computed tomography (MDCT) is used as a noninvasive method of quality control at our institution.

Methods: In 50 elective coronary artery bypass grafting patients who participated in a randomized trial comparing automated with conventionally hand-sewn proximal anastomoses, MDCT was performed on postoperative day 5. Fifty-three automated Symmetry anastomoses were created in 34 patients (group 1). Twenty-five conventionally hand-sewn anastomoses created in 16 patients served as controls (group 2). Graft patency and the presence or absence of high-grade stenosis at the proximal anastomotic site were evaluated.

Results: In group 1, 2 (3.8%) of the grafts were found occluded at MDCT or coronary angiography, and no further relevant stenosis was observed. In group 2, at postoperative MDCT all grafts were found patent without significant narrowing of the proximal anastomotic site.

Conclusions: The feasibility of proximal anastomoses using the Symmetry device has been reported. Patency control with invasive angiography has been performed by other groups. With MDCT, noninvasive evaluation of proximal anastomotic quality and graft patency is possible, even if nitinol is implanted.


Bateman TM, Gray RJ, Whiting JS, et al. 1987. Prospective evaluation of ultrafast cardiac computed tomography for determination of coronary bypass graft patency. Circulation 75:1018-24.nCalafiore AM, Bar-El Y, Vitolla G, et al. 2001. Early clinical experiences with a new sutureless anastomotic device for proximal anastomosis of the saphenous vein to the aorta. J Thorac Cardiovasc Surg 121:854-8.nEckstein FS, Bonilla LF, Engelberger L, et al. 2001. Minimizing aortic manipulation during OPCAB using the Symmetry aortic connector system for proximal vein graft anastomoses. Ann Thorac Surg 72:S995-8.nEngelmann MG, Knez A, von Smekal A, et al. 2000. Non-invasive coronary bypass graft imaging after multivessel revascularization. Int J Cardiol 76:65-74.nEngelmann MG, von Smekal A, Knez A, et al. 1997. Accuracy of spiral computed tomography for identifying arterial and venous coronary graft patency. Am J Cardiol 80:569-74.nFitzgibbon GM, Kafka HP, Leach AJ, Keon WJ, Hooper D, Burton JR. 1996. Coronary bypass graft fate and patient outcome: angiographic follow-up of 5,065 grafts related to survival and reoperation in 1,388 patients during 25 years. J Am Coll Cardiol 28:616-26.nFlohr T, Ohnesorg B. 2001. Heart rate adaptive optimization of spatial and temporal resolution for electrocardiogram-gated multislice spiral CT of the heart. J Comput Assist Tomogr 25:907-23.nGuyton RA, McClenathan JH, Michaelis LL. 1979. A mechanical device for sutureless aorta-saphenous vein anastomosis. Ann Thorac Surg 28:342-5.nLuisada AA, MacCanon DM. 1972. The phases of the cardiac cycle. Am Heart J 83:705-11.nOhnesorg B, Flohr T, Becker C, et al. 2000. Cardiac imaging by means of electrocardiographically gated multisection spiral CT: initial experience. Radiology 217:564-71.nStanford W, Brundage BH, MacMillan R, et al. 1988. Sensitivity and specificity of assessing coronary bypass graft patency with ultrafast computed tomography: results of a multicenter study. J Am Coll Cardiol 12:1-7.nvon Smekal A, Lachat M, Wildermuth S, Khan G, Turina M, Marincek B. 2000. Proximale Anastomosen aortokoronarer Bypässe. Radiologe 40:130-5.n



How to Cite

Martens, S., Herzog, C., Dietrich, M., Doss, M., Wimmer-Greinecker, G., & Moritz, A. (2005). Ultrafast Computed Tomography for Quality Control of Automated Proximal Anastomoses. The Heart Surgery Forum, 6(6), E170-E173. https://doi.org/10.1532/hsf.1137