Early results of aortic connector system for proximal anastomosis of the saphenous vein graft.

PURPOSE Our objective is to clarify the technical points in using the symmetry aortic connector system (ACS) compared with hand-sewing from clinical and angiographic results of the patients who underwent off-pump coronary artery bypass grafting (CABG). METHODS Among 84 patients who underwent CABG from January 2002 to August 2003, 36 off-pump CABGs were performed using at least one saphenous vein graft (SVG). Thirty proximal anastomosis of 17 patients were performed by ACS, and 30 proximal anastomosis of 19 patients were performed by hand-sewing under aortic side-clamping. Angiogram of the coronary arteries and grafts was carried out 18 days after the operation. RESULTS Comparing the preoperative characteristics and intraoperative characteristics between the ACS group and hand-sewing group, revealed no significant factors at all. Postoperative angiography of coronary arteries and grafts revealed that the four SVGs with ACS were occluded probably because of kinking near the proximal anastomosis site. On the other hand, all SVGs anastomosed by hand-sewing were patent. CONCLUSION ACS is very useful with easy handling during off-pump CABG, but it has potential limitations. In our limited experience, we have to mind the graft length as well as the position of proximal anastomosis so that the graft does not kink.