Thrombotic occlusion of the aortic ostia of saphenous venous grafts early after coronary artery bypass grafting by using the Symmetry aortic connector system

Donsky, Alan; Schussler, Jeffrey M.; Donsky, Michael S.; Roberts, William C.; Hamman, Baron L.

doi:10.1067/mtc.2002.124236

Cited by 31 publications

(18 citation statements)

References 5 publications

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“…Several reports have described ϳ5% technical failure rate due to loading of the vein on the device and/or deployment of the device, persistent bleeding around the device, or unrecognized dissection flaps created during formation of the aortotomy (1,2,8). In addition, in-hospital occlusions during the postoperative state have been described, although the investigators believed these were due to thrombotic disorder rather than device-related (9,10).…”

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confidence: 91%

Severe ostial saphenous vein graft disease leading to acute coronary syndromes following proximal aorto-saphenous anastomoses with the symmetry bypass connector device

Cavendish

Penny

Madani

et al. 2004

Journal of the American College of Cardiology

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The Symmetry Bypass Connector (St. Jude Medical, St. Paul, Minnesota) is a nitinol, star-shaped device that was designed to facilitate placement of sutureless aorto-saphenous anastomoses during off-pump coronary artery bypass graft surgery (CABG). Although the device is approved for clinical use in Europe and the U.S., its short- and long-term safety and efficacy are not established. We report on 5 of 121 patients undergoing CABG who presented with an acute coronary syndrome two to five months following placement of this device. In each patient, all saphenous vein grafts (SVGs) placed (n = 11) with the device were totally occluded (n = 6) or compromised by ostial stenoses (n = 5). Treatment consisted of repeat CABG in one patient and percutaneous coronary intervention (PCI) in four patients with cutting balloon atherotomy and stenting. Following PCI, two of four patients presented again within two months with near-occlusive ostial restenosis in all stents placed. Intracoronary ultrasound showed severe neointimal hyperplasia, but only at the proximal interface of the device and stent. One patient was treated with brachytherapy in two SVGs but had a recurrence four months later and was treated with drug-eluting stents in both restenotic segments. Recalcitrant neointimal hyperplasia is postulated to be involved in the pathogenesis of anastomotic device stenosis, possibly similar to in-stent restenosis. Prospective randomized clinical trials are needed to assess the clinical safety and efficacy of this device. Pending such studies, consideration should be given in limiting its use to cases of unacceptably high risk of stroke during aortic cross-clamping. Dual antiplatelet agents, evaluation for ischemia, and close follow-up are warranted in patients that have already received the device.

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mentioning

confidence: 91%

Severe ostial saphenous vein graft disease leading to acute coronary syndromes following proximal aorto-saphenous anastomoses with the symmetry bypass connector device

Cavendish

Penny

Madani

et al. 2004

Journal of the American College of Cardiology

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“…Patients were assigned to one of two groups: patients that experienced stenosis of the proximal anastomosis (Group 1: cases 1, 3, 4, 5), and patients that did not experience stenosis of the proximal anastomosis (Group 2: cases 6,7,8,9) (Table II). There was no significant difference in graft flow during surgery when comparing the two groups (Group l, 20.5_+21.5 ml/min; Group 2, 20.3_+ 16.3 ml/min; Table III) patients in Group 2, and 5.0-5.5 for three patients in Group 1 and two patients in Group 2 (Table IV).…”

Section: Resultsmentioning

confidence: 99%

Use of an aortic connector system for vein grafting

Inaba

Higuchi

Koseni

et al. 2005

Jpn J Thorac Caridovasc Surg

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“…Histological examination of the explanted bypass graft of one patient showed severe intimal fibrosis and partially recanalized thrombosis. Baylor University also reported complications in two patients who had complete thrombotic occlusion of the SVG ostia within the first week postoperatively [3]. Although both patients had conditions predisposing them to thrombosis, the authors state that the traditional suturing of the anastomosis rarely causes such thrombotic occlusions.…”

Section: Bypass Graft Patency and Aortic Connector Devicementioning

confidence: 96%

“…Emerging reports have established safety of this device and overall patency rates appear to be equivalent to historic suture-mediated anastomosis control, although large randomized trials are lacking. Early bypass graft failures have been reported, with few patients requiring redo CABG [3,4]. We report cases of early ostial saphenous vein graft stenosis associated with the use of the Symmetry connector successfully revascularized by percutaneous intervention and stenting.…”

Section: Introductionmentioning

confidence: 97%

Early ostial saphenous vein graft stenosis associated with the use of Symmetry sutureless aortic proximal anastomosis device: Successful percutaneous revascularization

Cline

Guduvalli

Kalaria

2004

Cathet Cardio Intervent

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A recent advance in technology permits the creation of sutureless proximal aortic anastomosis during coronary artery bypass graft surgery. This new tool has significant potential benefit by minimizing aortic manipulation with subsequent reduction in neuroembolization. Implantation of a nitinol-based proximal aortic connector (Symmetry) has a potential to elicit intimal hyperplastic reaction analogous to restenosis after coronary stent placement. We report cases of early vein graft stenosis in association with the use of the Symmetry device. Three patients suffered from severe ostial stenosis within 6 months of bypass surgery with symptomatic presentation. Of these three patients, two underwent successful percutaneous revascularization. Fluoroscopic star-shaped appearance of the metallic Symmetry allows device recognition during angiography. We review current data regarding graft patency with the use of Symmetry device and discuss technical issues to address specific problems during percutaneous revascularization.

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Thrombotic occlusion of the aortic ostia of saphenous venous grafts early after coronary artery bypass grafting by using the Symmetry aortic connector system

Cited by 31 publications

References 5 publications

Severe ostial saphenous vein graft disease leading to acute coronary syndromes following proximal aorto-saphenous anastomoses with the symmetry bypass connector device

Severe ostial saphenous vein graft disease leading to acute coronary syndromes following proximal aorto-saphenous anastomoses with the symmetry bypass connector device

Use of an aortic connector system for vein grafting

Early ostial saphenous vein graft stenosis associated with the use of Symmetry sutureless aortic proximal anastomosis device: Successful percutaneous revascularization

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