Forty-one-month follow-up of the Symmetry aortic connector system for proximal venous anastomosis

Bergmann, Peter G.; Meszaros, Katharina; Huber, Stefan; Oberwalder, Peter; Mächler, Heinrich; Schaffler-Schaden, Dagmar; Rienmueller, Rainer; Rigler, B

doi:10.1016/j.jtcvs.2007.02.007

Cited by 7 publications

(6 citation statements)

References 24 publications

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“…In the present case-control study, such outcomes could not be confirmed. In contradiction with other reports, 1,[7][8][9][10][11][12][13] in this study, the Symmetry device could not be identified as an independent risk factor for proximal vein graft failure. All coronary reinterventions caused by proximal vein graft failure took place in the first 28 months.…”

Section: Discussioncontrasting

confidence: 99%

“…Also several investigators have expressed their concern about the Symmetry device being a possible risk factor for proximal vein graft failure. 1,[7][8][9][10][11][12][13] Recently, Bergsland et al reported the long-term outcome of 23 patients operated with Symmetry proximal connector. 14 The authors concluded that nearly half of these patients underwent coronary reintervention or reported angina and use of nitroglycerin at late follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4][5][6] Nevertheless, the device was withdrawn from the market after some mid-term reports showed that the incidence of graft occlusion was as high as 50%. 1,[7][8][9][10][11][12][13] Long-term follow-up studies are still scarce. 14 In addition to the limited availability of long-term results, the outcome of patients in whom the Symmetry device was used is seldom placed into perspective by comparing it to the outcome of a control group in whom the proximal anastomoses was performed by conventional hand-sewn method.…”

Section: Introductionmentioning

confidence: 99%

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Long-Term Clinical Outcome of the Symmetry Aortic Connector System in Off-Pump Coronary Artery Bypass Grafting

Verberkmoes

Mokhles

Bramer

et al. 2012

Thorac cardiovasc Surg

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Long-Term Clinical Outcome of the Symmetry Aortic Connector System in Off-Pump Coronary Artery Bypass Grafting

Verberkmoes

Mokhles

Bramer

et al. 2012

Thorac cardiovasc Surg

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“…Other investigators confirmed these findings (105, 106) although a Japanese group showed better patency (107). In contrast to what was the case in our study, some of the Japanese patients received anti-thrombotic therapy in addition to aspirin.…”

Section: Discussionmentioning

confidence: 60%

Safe Introduction and Quality Control of New Methods in Coronary Surgery

Bergsland

2011

Acta Inform Med

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Introduction:The first part of the paper analyses off pump coronary bypass surgery (OPCAB), which is compared with traditional on-pump procedures (ONCAB). Furthermore ,the paper evaluates the use of a new automatic device for performance of the proximal anastomosis and finally the effect of intracoronary shunt on myocardial ischemia during OPCAB. The main goal of the paper is to demonstrate the importance of careful clinical studies during introduction of the new techniques in cardiac surgery.Methods:Statistical analysis was performed on a large clinical database from Buffalo, NY, USA comparing OPCAB and ONCAB. Subsequently, a sequential controlled clinical study compared patients operated with a new automatic connector device to patients operated with classic suture technique. Finally a randomized study was performed to evaluate the effect of the use of an intracoronary shunt during construction of distal anastomosis.Results:The studies from Buffalo demonstrated reduced complications rates in high risk patients when OPCAB techniques were used. The use of connector devices in saphenous venous anastomosis was clearly inferior to standard technique. Intracoronary shunt was found to be beneficial by preventing ischemia.Discussion:Numerous studies have studied the results of OPCAB vs ONCAB and although results are variable it seems that OPCAB is advantageous in high risk patients, while in low risk patients there are much less if any benefit. The results of the studies of connector devices caused the product to be taken off the market. The value of shunt in OPCAB was clearly demonstrated by the randomized studies.Conclusion:The investigations presented in this paper clearly demonstrates the importance of well-designed studies when new surgical methods are introduced. In the present period of rapid technological development, carefully controlled, un-biased clinical trials are crucial to preserve patient safety and avoid unjustified societal cost.

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“…The selected studies were prospective observational studies encompassing a total of 718 patients. [7][8][9][10][11][12][13]22,23 Table 1 shows the characteristics of the study populations included in every study. In addition, a description of the operative data is provided in Table 2.…”

Section: Characteristics Of the Studiesmentioning

confidence: 99%

Clinical outcomes of automated anastomotic devices: A metanalysis

et al. 2019

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Background and AimsWe investigated neurological events, graft patency, major adverse cardiovascular events (MACEs), and mortality at 1 year following coronary artery bypass grafting (CABG) surgery using automated proximal anastomotic devices (APADs) and compared the overall rates with the current literature.MethodsA systematic review of all available reports of APADs use in the literature was conducted. Cumulative incidence and 95% confidence interval (CI) were the main statistical indexes. Nine observational studies encompassing a total of 718 patients were included at the end of the selection process.ResultsThe cumulative event rate of neurological complications was 4.8% (lower‐upper limits: 2.8‐8.0, P < .001; I2 = 72.907%, P = .002; Egger's test: intercept = –2.47, P = 0.16; Begg and Mazumdar test: τ = −0.20, p = 0.57). Graft patency was 90.5% (80.4 to 95.7, P < .001; I2 = 76.823%, P = .005; Egger's test: intercept = –3.04, P = .10; Begg and Mazumdar test: τ = −0.67, P = .17). Furthermore, the overall incidence of MACEs was 3.7% (1.3‐10.4, P < .001; I2 = 51.556%, P = .103; Egger's test: intercept = –1.98, P = < .11; Begg and Mazumdar test: τ = −0.67, P = .17). Finally, mortality within 1 year was 5% (3.5‐7, P < .001; I2 = 29.675%, P = .202; Egger's test: intercept = –0.91, P = .62; Begg and Mazumdar test: τ = −0.04, P = .88).ConclusionsAPADs do not seem to be correlated with a reduction of either neurological events or mortality. By contrast, these tools showed satisfactory one‐year graft patency and a low incidence of MACEs. Further research on this topic is warranted.

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Forty-one-month follow-up of the Symmetry aortic connector system for proximal venous anastomosis

Abstract: Midterm follow-up data show a high number of occluded Symmetry aortic connector system vein grafts. On the basis of these observations, the use of the connector was abandoned at our institution.

Cited by 7 publications

References 24 publications

Long-Term Clinical Outcome of the Symmetry Aortic Connector System in Off-Pump Coronary Artery Bypass Grafting

Long-Term Clinical Outcome of the Symmetry Aortic Connector System in Off-Pump Coronary Artery Bypass Grafting

Safe Introduction and Quality Control of New Methods in Coronary Surgery

Clinical outcomes of automated anastomotic devices: A metanalysis

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