A New Clip Device for the Construction of Vascular Interrupted Anastomoses in Congenital Cardiac Surgery
Background: Many different mechanical vascular anastomotic devices have been developed recently, mostly rigid stenting mechanisms applicable only in coronary artery bypass grafting surgery. U-Clips, however, allow the precise construction of any vascular interrupted anastomosis, preserving pulsatility and perhaps growth potential.
Methods: We report the first use worldwide of U-Clips for congenital cardiac surgery in 10 pediatric patients (mean age, 2.3 ± 1.7 years). The operations took place between July 2001 and July 2002 for coarctation repair (3 patients), Glenn shunt (5 patients), Blalock-Taussig shunt (1 patient), and arterial switch (1 patient).
Results: Device handling, primary hemostasis, and patency were excellent, and no device-related complications occurred. Because of the learning curve, aortic cross-clamp times were significantly longer for the repair of coarctation with U-Clips than with the running-suture technique (21.7 ± 2.3 minutes versus 14.4 ± 2 minutes; P = .012). Postoperative recoveries were uneventful in all patients except for a baby with pulmonary atresia with intact ventricular septum, who died after 62 days. After a mean follow-up period of 11.9 ± 4.4 months, echocardiographic controls of all anastomoses showed nonturbulent flow without any restriction.
Conclusion: The U-Clip device may be a useful adjunct in congenital cardiac surgery for facilitating the creation of interrupted vascular anastomoses. Further evaluation is warranted for determining the long-term benefits of these devices with respect to growth preservation and restenosis.
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