Subject(s)
Aortic Diseases/diagnosis , Aortic Diseases/surgery , Community Networks , Dissection , Aged , Aged, 80 and over , Aortic Diseases/mortality , Aortic Diseases/physiopathology , Clinical Protocols/standards , Dissection/methods , Dissection/trends , Female , Humans , Male , Middle Aged , Models, Theoretical , Patient Care Team/organization & administration , Practice Guidelines as Topic , Program Evaluation , Survival Analysis , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: The use of aortic connectors for proximal saphenous vein bypass graft anastomoses eliminates the need for aortic clamping during coronary artery bypass grafting (CABG) and may reduce the incidence of stroke in the elderly and in patients with severe aortic atherosclerosis. METHODS AND RESULTS: We studied 74 consecutive patients who received the Symmetry Bypass System aortic connector at the time of CABG. A total of 131 of 144 proximal vein graft anastomoses were performed with this device. The left internal mammary artery was used in 62 patients, and 61 patients had "off-pump" coronary revascularization. A total of 11 patients were readmitted with chest pain consistent with unstable angina 173+/-39 days after CABG. Five of the 11 patients had previous in-stent restenosis before CABG. At angiography, 20 saphenous vein bypass grafts containing 19 connectors were found to have severe stenosis (n=12) or occlusion (n=6) and were treated with angioplasty and stenting or medical therapy. Seven of 11 patients were readmitted 76+/-11 days later with recurrent chest pain and were found to have severe stenosis at the previously stented connector site. Six patients underwent angioplasty followed by brachytherapy. Three of these patients redeveloped chest pain and were readmitted 151+/-71 days later. Two patients were started on oral Rapamune, and one patient underwent redo-CABG. CONCLUSIONS: Eleven of 74 patients who received aortic connectors at the time of CABG developed symptomatically significant stenosis or occlusion at the connector site shortly after CABG, requiring multiple repeat interventions, including brachytherapy.
Subject(s)
Aorta , Blood Vessel Prosthesis , Coronary Artery Bypass/methods , Saphenous Vein , Aged , Angioplasty, Balloon, Coronary , Aorta/surgery , Blood Vessel Prosthesis/adverse effects , Blood Vessel Prosthesis/statistics & numerical data , Brachytherapy , Chest Pain/etiology , Coronary Angiography , Coronary Artery Bypass/adverse effects , Coronary Artery Bypass/instrumentation , Coronary Restenosis/diagnosis , Coronary Restenosis/surgery , Equipment Failure/statistics & numerical data , Female , Follow-Up Studies , Humans , Internal Mammary-Coronary Artery Anastomosis/adverse effects , Laser Therapy , Male , Myocardial Infarction/diagnosis , Myocardial Infarction/therapy , Recurrence , Reoperation , Saphenous Vein/surgery , Stroke/etiology , Stroke/prevention & controlABSTRACT
Surgical techniques aimed at complete myocardial revascularization without the use of cardiopulmonary bypass are described. Between January 1998 and June 2000, coronary artery bypass was performed in 3,003 patients; an off-pump technique was used in 676 and cardiopulmonary bypass was employed in 2,327. Patient characteristics, demography, and preoperative risk factors of the two groups were compared retrospectively, and differences in operative variables and postoperative outcomes were analyzed. Using a commercially available suction stabilization device and the surgical and anesthetic techniques described herein, off-pump coronary revascularization was accomplished with results comparable to the on-pump approach.
