Vettath's Anastomotic Obturator: A Simple Proximal Anastomotic Device
Background: Off-pump coronary artery bypass grafting has been shown to improve the postoperative course of patients undergoing coronary artery bypass grafting (CABG) surgery, but the need for side-clamping the aorta to perform the proximal anastomosis is still a risk factor for causing neurologic injury postoperatively. Hence, our endeavor to fabricate an obturator to perform the proximal anastomosis without side-clamping the aorta is described.
Methods: From July 2002 to February 2003, we performed more than 150 CABG surgeries in our new cardiac center, and 92 patients had proximal saphenous vein graft anastomoses performed with Vettath's anastomotic obturator (VAO).
Results: A total of 147 CABG surgeries (98%) were performed on the beating heart, of which 135 (90%) were done off-pump. Early in our experience, the top ends were performed with side-clamping until we introduced our new VAO after trials on a perfused animal heart model. Ninety-two patients had proximal anastomoses carried out with the VAO, and 97 proximal anastomoses were performed on the aorta, because 5 of the patients had 2 proximal anastomoses. We had only one patient in our series who came back with angina after 3 months. Results of repeat coronary angiography with this patient showed a patent proximal anastomosis and no graft problems.
Conclusion: Our initial results with the VAO have been excellent. We have been able to use it in all of our proximal anastomoses of late. With regular practice, this procedure can be performed with ease and can definitely avoid the neurologic deficits caused by side-clamping the aorta.
Calafiore AM, Bar-el Y, Vitolla G, et al. 2001. Early clinical experience with a new sutureless anastomotic device for proximal anastomosis of the saphenous vein to the aorta. J Thorac Cardiovasc Surg 121:854-8.nMohan R, Amsel BJ, Walter PJ. 1992. Coronary artery bypass in the elderly: a review of studies on patients older than 64, 69 or 74 years. Cardiology 80:215-25.nMoshkovitz Y, Luski A, Mohr R. 1995. Coronary artery bypass without cardiopulmonary bypass: analysis of short-term and mid-term outcome in 220 patients. J Thorac Cardiovasc Surg 110:979-87.n
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