Avoidance of Aortic Side-Clamping for Proximal Bypass Anastomoses: Better Short-term Outcome?


  • Markus J. Wilhelm
  • Thomas Syburra
  • Lukas Furrer
  • Jürgen Frielingsdorf
  • Dragan Odavic
  • Kirk Graves
  • Michele Genoni




Objectives: The benefit of off-pump coronary artery bypass (OPCAB) surgery may be reduced by strokes caused by microemboli produced after aortic side-clamping for proximal bypass anastomoses. The Heartstring device allows constructing proximal bypass anastomoses without side-clamping of the aorta.

Methods: This retrospective study describes 260 consecutive patients who underwent OPCAB surgery; 442 proximal anastomoses were performed with the Heartstring device in this series. Ten percent of the patients were randomly sampled before discharge to undergo a coronary angiogram for assessment of graft patency.

Results: Intraoperative Doppler measurements confirmed regular bypass function. Early mortality occurred in 4 patients (1.5%), and stroke occurred in 2 patients (0.8%). Device-related bleeding was negligible, and there were no cases of aortic dissection. Perioperative ischemia occurred in 8 patients (3.1%). Predischarge coronary angiography evaluations in 25 of the patients (of 260) showed that all 42 Heartstring-assisted anastomoses (of 442) were patent. Conclusions: Clampless performance of proximal bypass anastomoses combined with OPCAB is associated with a very low incidence of stroke complications. Short-term follow-up has shown excellent results regarding bypass patency and other adverse events. Prospective randomized trials are required to confirm the advantage of this technique.


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How to Cite

Wilhelm, M. J., Syburra, T., Furrer, L., Frielingsdorf, J., Odavic, D., Graves, K., & Genoni, M. (2011). Avoidance of Aortic Side-Clamping for Proximal Bypass Anastomoses: Better Short-term Outcome?. The Heart Surgery Forum, 14(6), E360-E365. https://doi.org/10.1532/HSF98.20111036




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