Long-Term Outcomes of the Symmetry Vein Graft Anastomosis Device

Abstract

Background— The Symmetry Bypass Connector (St. Jude Medical) was developed to rapidly anastomose saphenous vein grafts to the aorta during coronary bypass surgery (CABG) without cross-clamping. Previous uncontrolled studies of this device observed vein graft closures at six months, possibly attributable to neointimal hyperplasia. Methods and Results— To assess the long-term clinical outcomes of the Symmetry device, we performed a retrospective matched case–control analysis of patients who underwent CABG at Duke Medical Center between January 1, 2002 and December 31, 2003. In 121 patients, at least one proximal anastomosis used a Symmetry device. Traditional suture methods were used in 178 control patients, matched by age group, gender, use of cardiopulmonary bypass, and Hannan perioperative risk score. One-year outcomes were compared using the log-rank test and Cox proportional hazards regression models. Major adverse events were more frequent among cases compared with controls. By unadjusted Kaplan–Meier analysis for the composite end point of death, nonfatal myocardial infarction, repeat cardiac catheterization, or repeat CABG, there was a trend towards increased events in the Symmetry device group ( P =0.053). No significant differences were detected for stroke, all cause mortality, or the combined end point of death or nonfatal myocardial infarction. Conclusions— Use of the Symmetry Bypass Connector was associated with increased risk for major adverse events at 1 year, suggestive of early graft closure. The potential reductions in operative stroke risk (from the elimination of aortic cross-clamping) must be weighed against the potential risk for later adverse events. These findings encourage close follow-up of patients who received this device.

Vascular anastomosis using controlled phase transitions in poloxamer gels

“…For nearly a century, suture-based vascular anastomoses have remained the gold standard despite their well-documented limitations. Numerous attempts have been made to develop alternatives to sutured vascular anastomosis because of the limitations of suture techniques when dealing with diseased or small vessels [11][12][13][14]33,34 . Here we demonstrate a new, nonmechanical and completely sutureless anastomosis technique capitalizing on the phase-transition properties of FDA-approved poloxamers and clinically used adhesives that is superior to the goldstandard hand-sewn anastomoses with respect to speed, patency in small vessels and long-term inflammation.…”

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

“…Kachy et al reported clinical outcomes of the Symmetry vein graft anastomosis device in a matched case-control study. 16 Their analyses showed a trend toward an increased risk for major adverse events at 1 year (p ¼ 0.053) and the authors suggested that this could be attributed to early graft closure. The present study demonstrates that this potential negative effect of the Symmetry device did not prove to be the case during a longer period of follow-up.…”

value of intra-operative epiaortic scanning in patients submitted for coronary artery bypass grafting

“…One such device allowed rapid vein graft anastomosis with the aorta without the need for cross-clamping. However, the higher risk of adverse outcome, including early graft closure precluded its wide spread adoption (10) .…”