The St Jude Medical symmetry aortic connector system for proximal vein graft anastomoses in coronary artery bypass grafting

Objectives: A new device designed to create proximal vein graft anastomoses to the aorta in coronary artery bypass grafting was recently developed by the St Jude Medical Anastomotic Technology Group (Minneapolis, Minn). This new anastomosis system consists of a nickel-titanium (nitinol) connector, an aortic cutter, and a delivery device. Methods: The loading of the vein on the aortic connector and its delivery to the aorta are described. In 43 consecutive patients (mean age 68 +/- 10 years, age range 33-91 years), 65 proximal vein graft anastomoses were performed with the new system. Intraoperative flow rates were assessed for all grafts according to the transit time principle. Results: All connector anastomoses were performed without the use of any aortic clamp. Times to complete these mechanical anastomoses were less than 10 seconds in all cases. Hemostasis was instantaneous in all cases, with only 3 system failures. These connectors were easily removed so that the anastomoses could be performed with standard suturing technique through the same aortotomy without complications. All vein grafts were patent at the end of the procedure, and there were no intraoperative or postoperative complications related to the device. Conclusions: The aortic connector system was easy to handle and allowed quick creation of reliable, reproducible, and uniform anastomoses. In addition, anastomoses could be done without any clamping of the aorta, which is especially attractive for off-pump procedures, because aortic manipulation and therefore the risks of embolism and aortic dissection would be further minimized. In on-pump cases this technique would facilitate the single-clamp technique, again minimizing aortic manipulation.