Vinod H. Thourani, Shady M. Eldaieef, Christopher Mutrie, Thomas A. Vassiliades, Omar M. Lattouf, Robert A. Guyton, Caleb Rutledge, John D. Puskas.
Emory University, Atlanta, GA, USA.
OBJECTIVE: Ascending aortic crossclamping for proximal coronary anastomoses may increase the risk of postoperative stroke. The objective of this study was to evaluate the safety of the Heartstring™ device in the construction of proximal coronary anastomoses in patients undergoing isolated coronary artery bypass grafting (CABG). METHODS: From 8/2003 to 12/2006, intraoperative epivascular ascending aortic ultrasound was used to grade atherosclerosis (Grades 1: minimal atherosclerosis to Grade 5: severe mobile atherosclerosis) in 426 patients undergoing CABG at a single academic US center. The Heartstring™ device was used to construct 647 clampless proximal coronary anastomoses. Data are presented as mean±standard deviation. RESULTS: The mean age of all patients was 67.5±10.1 years and 279 (65.5%) were male. Seventy-six patients (17.8%) had sustained a preoperative neurologic event (CVA and TIA). The majority of patients (n=201, 94.1%) were performed off-pump. The average number of Heartstring™ devices utilized were 1.5±0.6 (median=1) and surgical sequential anastomoses were frequently utilized. There were no aortic dissections resulting from placement of the Heartstring™ device. The average number of distal anastomoses were 3.0±1.0 (median=3). In all patients, a total of 3 patients (0.7%) suffered a postoperative stroke: 1 patient (0.5%) with minimal ascending aortic atherosclerosis (Grades 1 or 2, n=188), 1 patient (0.6%) with moderate ascending aortic atherosclerosis (Grade 3, n=177), and 1 patient (1.6%) with severe ascending aortic atherosclerosis (Grades 4 or 5, n=61). The overall postoperative LOS was 7.5±6.2 (median 6 days) and in-hospital mortality was 7 patients (1.6%). CONCLUSIONS: The clampless proximal anastomoses utilizing the Heartstring™ device can be safely performed in patients undergoing CABG resulting in minimal stroke risk. With the burden of aortic atherosclerotic disease contributing to increasing risk for postoperative stroke, a clampless procedure remains a valuable tool for the practicing cardiac surgeon.
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