U-clip versus standard running suture for the central arterial T-graft anastomosis: A prospective randomized 64 slice CT evaluation 2 weeks and 6 months postoperatively

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Martin Oberhoffer¹, Sandra Eifert¹, Susanna Kober¹, Konstantin Nikolaou², Bruno Reichart¹, Calin Vicol¹.
¹Cardiac Surgery, Ludwig Maximilians University Munich, Munich, Germany, ²Institute of Diagnostic Radiology, Ludwig Maximilians University Munich, Munich, Germany.

Objective: The interrupted suture technique using U-clip for graft anastomoses in coronary surgery may be superior to standard running suture using polypropylene material because of the postulated compliance and elasticity of the created anastomosis. Internal thoracic arteries used as bypass graft could adapt their diameter to the blood flow. Based on these facts we hypothesized that a central T-graft RITA-to-LITA anastomosis created with U-clips possesses growth potential.
Methods: Thirty patients underwent total arterial revascularization using a T-graft (LITA in situ-to-LAD and free RITA-to-circumflex artery). In all cases free RITA was used as a sequential graft with 2 peripheral anastomoses. Patients were randomly assigned to 2 groups of 15 patients each: group A central T-graft anastomosis was performed using a standard 8-0 polypropylene running suture; group B central anastomosis was performed using U-clips.
Results: Transit time flow measurement showed patent grafts in all patients. In group B 12.4 (10-16) U-clips were used pro anastomosis. There were no hospital deaths. Patency control was performed in all patients 2 weeks and 6 months postoperatively using 64 slice CT. LITA diameter was measured proximal and distal and the diameter of the RITA distal to the central T-graft anastomosis. These data were compared. Two weeks postoperatively all grafts were patent. At 6 months, one RITA and one LITA (both group B) were closed distal to the central T-graft anastomosis. There was no death and no reintervention during follow-up. Statistical analysis showed no difference between the two groups at 2 weeks and 2 months. There was also no difference between the results at 2 weeks and 6 months in the same group. We couldn’t demonstrate any significant changes in the grafts diameter 6 months postoperatively (Table).

Graft diameter with respect to central T-graft anastomosis	Group A at 2 weeks	Group A at 6 months	Group B at 2 weeks	Group B at 6 months
LITA proximal (mm)	25.67	26.60	26.25	26.40
LITA distal (mm)	23.60	22.70	24,73	25.10
RITA (mm)	22.40	21.20	24.09	22.90

Conclusions: The U-clip interrupted anastomosis technique is in our experience safe but not superior to the standard running suture. Remodelling of the ITA grafts close to the central T-graft anastomosis was neither observed for the standard running suture nor for the U-clip created anastomoses.

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