Histological aspects of the saphenous vein damage with the use of the symmetry® aortic connector system

Abstract

The purpose of the present study was to analyze the histological aspects of the saphenous veins after the use of the Symmetry aortic connector in off pump coronary artery bypass surgery (OPCAB). Nineteen consecutive patients who underwent OPCAB surgery and who received one proximal saphenous vein anastomosis using the St Jude aortic Symmetry connector system were evaluated. In each patient one small segment of the saphenous vein was cut before the use of the Symmetry connector (V0), then another segment after (V1). All segments were stored in an acetone-formaldehyde-alcohol solution before examination. Examination of the V0 segments showed non-specific media fibrosis. In V1, 11 segments presented with a complete alteration of the endothelial layer (58%) and 8 with severe lesions (more than 80%). Among all the V1 segments, 8 had a dissection of the media (42%) and one presented with a wall thrombus. These results suggest that the use of the aortic connector can be associated with different types of lesions of the venous wall. Thus, further investigation and especially long-term follow-up are mandatory to evaluate the consequences of such lesions upon the grafts' patency.

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

“…The histopathologic study of Farhat and coworkers 24 shows a further possible cause of graft occlusion. Connector application caused complete alteration of the endothelium in 58%; more than 80% of those showed severe lesions of the vascular wall, in 42% there was dissection of the media, and in 5%, a complete thrombus on the vascular wall.…”

Clinical outcomes of automated anastomotic devices: A metanalysis

“…Histopathological evidence seems to confirm the endothelial damage caused by the device, as well as dissection of the tunica media in some cases. 32 Puskas et al 7 attributed these changes to endothelial damage because of the quantity of external material implanted.…”

A multicenter prospective randomized trial of a second-generation anastomotic device in coronary artery bypass surgery

“…Another issue was the need for introduction of a transfer sheath into the vein graft, with at least the potential for endothelial injury. 9 So that these issues could be addressed, a second-generation device was developed that allowed angled anastomoses and did not require instrumentation of the retained segment of the vein graft. The aim of this multicenter prospective randomized trial was to investigate the safety and efficacy of this second-generation anastomotic connector system.…”