Initial Experience of an Automated Anastomotic Distal Device in Off-Pump CABG


  • Ki-Bong Kim
  • Kwang Ree Cho
  • Jae-Sung Choi
  • Eun Hee Ki



Background: Recent progress in minimally invasive technology in the field of coronary artery bypass grafting (CABG) stimulates interest in anastomotic devices used to facilitate distal coronary anastomosis. We assessed the feasibility of the automated anastomotic distal device (AADD) on arterial grafts in patients who underwent off-pump CABG (OPCAB) and evaluated the early anastomotic patency and clinical results of the AADD based on an elliptical nitinol ring with attached 8 pins.

Methods: Fourteen patients scheduled for multivessel OPCAB using arterial grafts between August 2003 and February 2004 were studied. Among 19 patients enrolled, 5 patients were excluded: 2 patients because of failure of graft flaring onto the implant pins, 2 because of small and diseased target coronary artery (<1.5 mm in diameter), and 1 because of conversion to cardiopulmonary bypass. The distal anastomosis using the AADD was performed for the nondominant coronary artery.

Results: The total number of distal anastomoses was 48 (34 hand-sewn sutures and 14 AADD sutures), and the average number of distal anastomoses per patient was 3.4 ± 1.0. The grafts used for the AADD were right gastroepiploic artery (RGEA) in 10 patients, saphenous vein anastomosed to the end of the RGEA in 2 patients, and internal thoracic artery in 2 patients. The average time required for distal anastomosis using the AADD (from arteriotomy to anastomosis completion) was 2.9 ± 0.7 minutes (range, 1.5-4 minutes). The mean flow and pulsatility index of the AADD grafts measured intraoperatively by transit time flow measurement were 20.0 ± 10.3 mL/min and 2.4 ± 1.2, respectively. Early postoperative coronary angiographies demonstrated widely patent grafts in 32 of 34 hand-sewn anastomoses and 13 of 14 AADD sutures. There were no adverse events related to the use of the device.

Conclusions: Our initial experience demonstrated that distal anastomosis using the AADD was feasible in most of the patients who underwent OPCAB using arterial grafts. Distal anastomosis using the AADD had the advantage of shortening the actual suturing duration and might provide a method for standardizing the anastomotic procedure.


Chavanon O, Perrault LP. 1999. Favorable aspect of stapled anastomosis: an endothelial function study. Ann Thorac Surg 68:1443-4.nEckstein FS, Bonilla LF, Englberger L, et al. 2002. First clinical results with a new mechanical connector for distal coronary artery anastomoses in CABG. Circulation 106:I1- 4.nEmery RW, Eales F, Van Meter CH Jr, et al. 2001. Ventriculocoronary artery bypass results using a mesh-tipped device in a porcine model. Ann Thorac Surg 72:S1004-8.nFilsoufi F, Farivar RS, Aklog L, et al. 2004. Automated distal coronary bypass with a novel magnetic coupler (MVP system). J Thorac Cardiovasc Surg 127:185-92.nGundry SR, Black K, Izutani H. 2000. Sutureless coronary artery bypass with biologic glued anastomoses: preliminary in vivo and in vitro results. J Thorac Cardiovasc Surg 120:473-7.nKim K-B, Cho KR, Chang W-I, Lim C, Ham BM, Kim YL. 2002. Bilateral skeletonized internal thoracic artery graftings in off-pump coronary artery bypass: early result of Y versus in situ grafts. Ann Thorac Surg 74:S1371-7.nNataf P, Hinchliffe P, Manzo S, et al. 1998. Facilitated vascular anastomoses: the one-shot device. Ann Thorac Surg. 66:1041-4.nSchaff HV, Zehr KJ, Bonilla LF, et al. 2002. An experimental model of saphenous vein-to-coronary artery anastomosis with the St. Jude medical stainless steel connector. Ann Thorac Surg 73:830-6.nScheltes JS, Heikens M, Pistecky PV, et al. 2000. Assessment of patented coronary end-to-side anastomotic devices using micromechanical bonding. Ann Thorac Surg 70:218-22.nSolem JO, Boumzebra D, Al-Buraiki J, et al. 2000. Evaluation of a new device for quick sutureless coronary artery anastomosis in surviving sheep. Eur J Cardiothoracic Surg 17:1046-8.nZehr KJ, Hamner CE, Bonilla LF, et al. 2003. Evaluation of a novel 2mm internal diameter stainless steel saphenous vein to coronary artery connector: laboratory studies of on-pump and off-pump revascularization. Eur J Cardiothorac Surg 23:925-34.nBar-El Y, Tio FO, Shofti R. 2003. An automatic sutureless coronary anastomotic device: initial results of an animal study. Heart Surg Forum 6:369-74.nBass LS, Treat MR, Dzakonski C, et al. 1989. Sutureless microvascular anastomosis using the THC: YAG laser: a primarily report. Microsurgery 10:189-93.n



How to Cite

Kim, K.-B., Cho, K. R., Choi, J.-S., & Ki, E. H. (2005). Initial Experience of an Automated Anastomotic Distal Device in Off-Pump CABG. The Heart Surgery Forum, 7(5), E360-E363.




Most read articles by the same author(s)