Background: In November 2005 a new automated distal anastomotic device (C-Port) for use in coronary artery bypass grafting (CABG) was cleared for use in the United States by the FDA. This study represents a prospective evaluation of our early experience utilizing the device and patency of the grafts as determined by 64 slice multi-detector row computed tomography angiography (MDCTA).
Methods: Patients undergoing coronary artery bypass were evaluated preoperatively by cine angiography for possible use of the C-Port system. A final decision for its use was made clinically at operation based on target vessel and vein graft specifications. Intraoperative flows were assessed using the Medi-Stem Flowmeter. Patency of the grafts was evaluated at 1 to 7 months (average 76 days) by MDCTA with IRB approval and signed informed consent.
Results: The C-Port device was utilized to form 58 distal anastomoses in 49 patients (45 CABG were performed off pump). There were 8 misfires with no adverse effects for an immediate success rate of 86%. Following hospital acquisition of the Medi-Stem Flowmeter assessment of flow was performed on the most recent 16 C-Port grafts with an average flow of 40.7 ml/min (16-105), an average pulsatility index of 2.8 (1.5-6.6) and an average diastolic filling of 60.5% (24-79). Thirty-four of 40 patients were available for evaluation by MDCTA at 1 to 7 months (85% followup). There was one postoperative death. Seventeen sequential anastomoses were excluded due to inability to reliably evaluate patency by MDCTA. The overall patency rate for all anastomoses was 91% (87/96) with selected patency of 100% (29/29) for internal mammary artery, 83% (19/23) for hand-sewn venous and 89% (39/44) for C-Port. The difference in patency between hand-sewn and C-Port anastomoses was not statistically significant (p=0.57).
Conclusions: The C-Port system provides reliable and reproducible compliant automated distal venous anastomoses which results in an excellent flow profile and acceptable patency at intermediate followup. With proper training the learning curve for using this connector system is short and the need to abandon the procedure is low.