ABSTRACT 16

THE ST. JUDE MEDICAL AORTIC CONNECTOR SYSTEM FOR PROXIMAL VEIN GRAFT ANASTOMOSES IN CABG AS AN ADDITIONAL ADJUNCT TO MINIMIZE AORTIC MANIPULATION

Friedrich S. Eckstein, Luis F. Bonilla, Todd Berg, Lars Englberger, Jürg Schmidli, Thierry P. Carrel

Clinic for Cardiovascular Surgery, University Hospital, Bern, Switzerland

OBJECTIVE: The sutureless aortic connector system (St. Jude Medical, Minneapolis, MN, USA) was recently developed to facilitate the creation of an aorto-saphenous vein anastomosis for CAB surgery . The device consists of an aortic cutter, delivery system and a self-expanding Nickel Titanium (Nitinol) connector.

METHODS: In 14 consecutive patients (mean age: 69±8 years, range: 52-81 years) 14 LITA's, 3 radial arteries and 23 vein grafts were used as bypass conduits. Twenty proximal vein graft anastomoses were performed with the aortic connector system. All patients underwent CABG without CPB. Intraoperative blood flows were measured in all the grafts.

RESULTS: Mean loading time for the connector was 5.0±1.2 min. All connector anastomoses were performed without aortic clamping. Time to complete these mechanical anastomoses was less than 10 sec. Hemostasis was instantaneous in all cases except one. The connector was removed and the anastomosis was hand-sewn without complications. All vein grafts were patent at the end of the procedure, flow measurements for single vein grafts (n=10) was 38±20ml/min and 71±31 ml/min for sequential grafts (n=9). There were no postoperative complications related to the device.

CONCLUSIONS: The aortic connector system is quick and reliable and allows the creation of uniform and reproducible anastomoses without any aortic clamping, being especially attractive for off-pump procedures. This device represents a further step to reduce manipulation of the aorta with the potential risk of embolization.