medigraphic.com
ISSN 2594-1518 (Electronic)
ISSN 1405-0099 (Print)

2009, Number 2

<< Back Next >>

Cir Gen 2009; 31 (2)

Initial clinical experience with the HEARTSTRING, a proximal anastomosis device in coronary surgery

Rodríguez-Ortega MF, Palma-Mercado J, Hernández-Mercado MA, Gómez-Ríos N, Acevedo-Corona A, Martínez-Rivera JC

Language: Spanish
References: 17
Page: 110-114
PDF size: 176.63 Kb.


ABSTRACT

Objective: To report the initial experience with the use of the Heartstring device.
Setting: Medical Center ISSEMyM (first level health care hospital).
Design: Case series.
Statistical analysis: Percentages as summary measure for qualitative variables.
Patients and methods: The device was used in 15 patients needing coronary revascularization, without cardiopulmonary shunting. Analyzed variables were: age, gender, coronary disease, risk factor for ischemic disease, number of implanted grafts, time to perform the proximal anastomosis, evolution and morbidity and mortality.
Results: The Heartstring device was used in all cases. Average age of patients was 55 ± 9.3 years; most of them were men. Disease in two vessels in 12 patients and in three vessels in 3 patients, mean time required to perform the proximal anastomosis was of 6.5 ± 1.3 minutes (range from 5 to 11); there were four post-operative complications. No neurological complications were encountered in any case, evolution was satisfactory in 100% of cases at 15 months of follow-up.
Conclusion: The Heartstring offers safety, easiness, and speed, and is reproducible to perform proximal anastomoses; thereby, avoiding aortic clamping. Its use decreases the incidence of cerebrovascular events and of neurological complications.


REFERENCES

  1. Roach GW, Kanchuger M, Mangano CM, Neuman M, Nussmeier N, Wolman R, et al. Adverse cerebral outcomes alter coronary artery bypass surgery: Multicenter Study of Perioperative Ischemia Research Group and the Ischemia Research and Education Foundation Investigators. N Engl J Med 1996; 335: 1857-63.

  2. Scheltes JS, Van Andel CJ, Pistecky PV, Borst C. Coronary anastomotic devices: blood-exposed non-intimal surface and coronary wall stress. J Thorac Cardiovasc Surg 2003; 126: 191-9.

  3. Riess F-C, Helmold H, Hilfer I, Bader R, Stripling J, Loewer C, et al. Clinical experience with the CorLink device for proximal anastomosis of the saphenous vein to the aorta: a clinical, prospective, and randomized study. Heart Surg Forum 2002; 5: 345-53.

  4. Nollert G, Oberhoffer M, Reichart B, Vicol C. Combination of the HEARTSTRING proximal seal system with a blower mister: a possible source of gas emboli. J Thorac Cardiovasc Surg 2003; 126: 1192-4.

  5. Vicol C, Oberhoffer M, Nollert G, Eifert S, Boekstegers P, Wintersperger B, et al. First clinical experience with the Heartstring, a device for proximal anastomoses in coronary surgery. Ann Thorac Surg 2005; 79: 1732-7.

  6. Bojar RM. Cardiopulmonary Bypass. En: Bojar MR. Manual of perioperative care in adult cardiac surgery, 4a edition, Somerset Wiley-Blackwell 2004: 178-203.

  7. Elefteriades JA, Zaret B. Coronary Bypass: the bad ventricle. En: Kaiser LR, Kron IL, Spray TL. Mastery of cardiothoracic surgery, 3a edition, 1998, Philadelphia Lippincott-Raven Publishers. 1998: 408-19.

  8. Newman MF, Kirchner JL, Phillips-Bute B, Garver V, Grocott H, Jones RH, et al. Longitudinal assessment of neurocognitive function after coronary-artery bypass surgery. N Engl J Med 2001; 344: 395-402.

  9. Van Dijk D, Jansen EW, Hijman R, Nierich AP, Diephuis JG, Moons KG, et al. Cognitive outcome after off-pump and on-pump coronary artery bypass graft surgery: a randomized trial. JAMA 2002; 287: 1405-12.

  10. Butler RJ. Neurologic complications and management. En: Cheng DCH, David TE. Perioperative care in cardiac anesthesia and surgery. 2006, Philadelphia Lippincott Williams & Wilkins. 2006: 415-19.

  11. Guadalajara JF. Cardiopatía isquémica, Cap. 22, pp.: 671-722. En: Guadalajara JF. Cardiología, 2001, 5a edición, Mendez Editores, México.

  12. Bar-El Y, Goor DA. Clamping of the atherosclerotic ascending aorta during coronary artery bypass operations: its cost in strokes. J Thorac Cardiovasc Surg 1992; 104: 469-74.

  13. Eckstein FS, Bonilla LF, Englberger L, Stauffer E, Berg TA, Schmidt J, et al. Minimizing aortic manipulation during OPCAB using the symmetry aortic connector system for proximal vein graft anastomoses. Ann Thorac Surg 2001; 72: S995-8.

  14. Marck MJ, Emery RW, Ley LR, Cole PA, Leonard A, Edgerton JR, et al. Initial experience with proximal anastomoses performed with a mechanical connector. Ann Thorac Surg 2003, 75:1866-71.

  15. Calafiore AM, Bar-El Y, Vitolla G, Di Giammarco G, Teodori G, Iacò AL, et al. Early clinical experience with a new sutureless anastomotic device for proximal anastomosis of the saphenous vein to the aorta. J Thorac Cardiovasc Surg 2001; 121: 854-8.

  16. Antona C, Scrofani R, Lemma M, Vanelli P, Mangini A, Danna P, et al. Assessment of an aortosaphenous vein graft anastomotic device in coronary surgery: clinical experience and early angiographic results. Ann Thorac Surg 2002; 74: 2101-5.

  17. Carrel TP, Eckstein FS, Englberger L, Windecker S, Meier B. Pitfalls and key lessons with the symmetry proximal anastomotic device in coronary artery bypass surgery. Ann Thorac Surg 2003; 75: 1434-6.




2020     |     www.medigraphic.com