Guidant Heartstring: Initial Experience in OPCAB Surgery
DOI:
https://doi.org/10.1532/HSF98.20041113Abstract
Purpose: The aim of this study was to evaluate the feasibility of the Heartstring hemostatic seal system for proximal anastomoses without the need for aortic side clamping in off-pump coronary artery bypass surgery .
Material and Methods: Between May and November 2003, 50 proximal bypass anastomoses were performed with the Heartstring device in 29 consecutive patients (21 men, 8 women) with calcified aorta (assessed by transesophageal echocardiography/digital palpation). Mean patient age was 68 ± 7 years. A mean of 1.7 anastomoses per patient was performed. Bypass patency was assessed by intraoperative flow measurements. Neurological outcome was graded in 4 severities.
Results: The learning curve was completed after deployment of approximately 10 devices. Crack of the seal prior to deployment occurred in 8 cases. No conversion to conventional side clamping was needed. No accidental stitching of the seal or wrapping of the suture around the seal stem occurred. Slight diffuse bleeding occurred with arterial pressure under 65 mm Hg. Bypass graft flow was 53.7 ± 23.9 L/min. No perioperative ischemic events occurred, and there were no postoperative neurological complications.
Conclusions: Proximal bypass aortic anastomoses can be performed safely without side clamping using the Heartstring hemostatic seal system. Anastomoses can be completed with no foreign material (stent) remaining.
References
Angelini GD, Taylor FC, Reeves BC, Ascione R. 2002. Early and midterm outcome after off-pump and on-pump surgery in beating heart against cardioplegic arrest studies (BHACAS 1 and 2): a pooled analysis of two randomised controlled trials. Lancet 359:1194-9.nArom KV, Flavin T, Emery RW, et al. 2000. Safety and efficacy of off-pump coronary artery bypass grafting. Ann Thorac Surg 69:704-10.nGuidant Corporation. 2002. Heartstring Proximal Seal System. Instructions for use. Santa Clara, Calif. Iaco AL, Contini M, Teodori G, et al. 1999. Off or on bypass: what is the safety threshold? Ann Thorac Surg 68:1486-9.nLev-Ran O, Loberman D, Matsa M, et al. 2004. Reduced strokes in the elderly: the benefits of untouched aorta off-pump coronary surgery. Ann Thorac Surg 77:102-7.nMatata BM, Sosonowski AW, Galinanes M. 2000. Off-pump bypass graft operation significantly reduces oxidative stress and inflammation. Ann Thorac Surg 69:785-91.nMontgomery DH, Ververis JJ, McGorisk G, Frohwein S, Martin RP, Taylor WR. 1996. Natural history of severe atheromatous disease of the thoracic aorta: a transesophageal echocardiograhic study. JACC 27(1):95-101.nNollert G, Oberhoffer M, Reichart B, Vicol C. 2003. Combination of the heartstring proximal seal system with a blower mister: a possible source of gas emboli. J Thorac Cardiovasc Surg 126:1192-4.nPuskas JD, Williams WH, Duke PG, et al. 2003. Off-pump coronary artery bypass grafting provides complete revascularization with reduced myocardial injury, transfusion requirements and length of stay: a prospective randomized comparison of two hundred unselected patients undergoing off-pump versus conventional coronary artery bypass grafting. J Thorac Cardiovasc Surg 125:797-808.nReuthebuch O, Kadner A, Lachat M, Kuenzli A, Schurr, U, Turina M. 2004. Early bypass occlusion after deployment of Nitinol connector devices. J Thorac Cardiovasc Surg 127(4):1-6.nStamou SC, Jablonski KA, Pfister AJ, et al. 2002. Stroke after conventional versus minimally invasive coronary artery bypass. Ann Thorac Surg 74:394-9.n
