Vettath's Anastomotic Obturator: A Simple Proximal Anastomotic Device
DOI:
https://doi.org/10.1532/hsf.1138Abstract
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.
References
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
Published
How to Cite
Issue
Section
Author Disclosure & Copyright Transfer Agreement
In order to publish the original work of another person(s), The Heart Surgery Forum® must receive an acknowledgment of the Author Agreement and Copyright Transfer Statement transferring to Forum Multimedia Publishing, L.L.C., a subsidiary of Carden Jennings Publishing Co., Ltd. the exclusive rights to print and distribute the author(s) work in all media forms. Failure to check Copyright Transfer agreement box below will delay publication of the manuscript.
A current form follows:
The author(s) hereby transfer(s), assign(s), or otherwise convey(s) all copyright ownership of the manuscript submitted to Forum Multimedia Publishing, LLC (Publisher). The copyright transfer covers the exclusive rights to reproduce and distribute the article and the material contained therein throughout the world in all languages and in all media of expression now known or later developed, including but not limited to reprints, photographic reproduction, microfilm, electronic data processing (including programming, storage, and transmission to other electronic data record(s), or any other reproductions of similar nature), and translations.
However, Publisher grants back to the author(s) the following:
- The right to make and distribute copies of all or part of this work for use of the author(s) in teaching;
- The right to use, after publication in The Heart Surgery Forum, all or part of the material from this work in a book by the author(s), or in a collection of work by the author(s);
- The royalty-free right to make copies of this work for internal distribution within the institution/company that employs the author(s) subject to the provisions below for a work-made-for-hire;
- The right to use figures and tables from this work, and up to 250 words of text, for any purpose;
- The right to make oral presentations of material from this work.
Publisher reserves the right to grant or refuse permission to third parties to republish all or part of the article or translations thereof. To republish, such third parties must obtain written permission from the Publisher. (This is in accordance with the Copyright Statute, United States Code, Title 17. Exception: If all authors were bona fide officers or employees of the U.S. Government at the time the paper was prepared, the work is a “work of the US Government” (prepared by an officer or employee of the US Government as part of official duties), and therefore is not subject to US copyright; such exception should be indicated on signature lines. If this work was prepared under US Government contract or grant, the US Government may reproduce, royalty-free, all or portions of this work and may authorize others to do so, for official US Government purposes only, if the US Government contract or grant so requires.
I have participated in the conception and design of this work and in the writing of the manuscript and take public responsibility for it. Neither this manuscript nor one with substantially similar content under my authorship has been published, has been submitted for publication elsewhere, or will be submitted for publication elsewhere while under consideration by The Heart Surgery Forum, except as described in an attachment. I have reviewed this manuscript (original version) and approve its submission. If I am listed above as corresponding author, I will provide all authors with information regarding this manuscript and will obtain their approval before submitting any revision. I attest to the validity, accuracy, and legitimacy of the content of the manuscript and understand that Publisher assumes no responsibility for the validity, accuracy, and legitimacy of its content. I warrant that this manuscript is original with me and that I have full power to make this Agreement. I warrant that it contains no matter that is libelous or otherwise unlawful or that invades individual privacy or infringes any copyright or other proprietary right. I agree to indemnify and hold Publisher harmless of and from any claim made against Publisher that relates to or arises out of the publication of the manuscript and agree that this indemnification shall include payment of all costs and expenses relating to the defense of any such claim, including all reasonable attorney’s fees.
I warrant that I have no financial interest in the drugs, devices, or procedures described in the manuscript (except as disclosed in the attached statement).
I state that the institutional Human Subjects Committee and/or the Ethics Committee approved the clinical protocol reported in this manuscript for the use of experimental techniques, drugs, or devices in human subjects and appropriate informed consent documents were utilized.
Furthermore, I state that any and all animals used for experimental purposes received humane care in USDA registered facilities in compliance with the “Principles of Laboratory Animal Care” formulated by the National Society for Medical Research and the “Guide for the Care and Use of Laboratory Animals” prepared by the Institute of Laboratory Animal Resources and published by the National Institutes of Health (NIH Publication No. 85-23, revised 1985).
