Outcomes after aortic graft-to-graft anastomosis with an automated circular stapler: A novel approach

Idrees, Jay J.; Yazdchi, Farhang; Soltesz, Edward G.; Vekstein, Andrew M.; Rodriguez, Christopher; Roselli, Eric E.

doi:10.1016/j.jtcvs.2016.06.039

Cited by 3 publications

(3 citation statements)

References 15 publications

(22 reference statements)

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“…Since their invention, surgical staplers have been routinely used in pulmonary and gastrointestinal procedures. However, there are few studies in which circular stapling devices, such as the Intraluminal Stapler System 18 (Ethicon, Somerville, NJ) and the EEA Stapler 19 (Covidien, Mansfield, Mass), have been used in aortic surgery. To form the anastomosis, the anvil is tied into one end of the aorta with a polypropylene purse-string suture.…”

Section: Aad Typesmentioning

confidence: 99%

“…A total of 41 studies 10,11,13,14,[16][17][18][19] were identified that reported outcomes for the use of AADs during surgery for thoracic and abdominal aortic reconstruction (Supplementary Tables I and II, online only). The meta-analysis included 27 studies with 50 cohorts, incorporating 1260 patients (Supplementary Table I, online only).…”

Section: Description Of Studiesmentioning

confidence: 99%

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Α systematic review and meta-analysis of the efficacy of aortic anastomotic devices

Manolesou

Papaioannou

Georgiopoulos

et al. 2019

Journal of Vascular Surgery

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Objective: One of the factors contributing to complications related to open repair of the aorta is the construction of a hand-sewn anastomosis. Aortic anastomotic devices (AADs), such as the intraluminal ringed graft (IRG), and the anastomotic stenting technique have been developed to perform a sutureless and less complicated anastomosis. This study performed a systematic review and meta-analysis of the literature reporting clinical use of AADs and aimed to assess, primarily, the effect of each device on 30-day overall and operation-related mortality and aortic cross-clamping time and, secondarily, the rate of successful two-sided application of the IRG device and the operation-related morbidity for each device.Methods: An electronic search was performed using MEDLINE, Scopus, ScienceDirect, and Cochrane Library by two independent authors. Our exclusion criteria included studies incorporating fewer than three patients and studies reporting results solely from animals or in vitro testing, results solely from end-to-side anastomosis, and results solely from endarterectomy procedures. The last search date was February 1, 2018.Results: A total of 41 studies were identified that reported outcomes for the use of three different device types: IRG, anastomotic stenting technique, and surgical staplers. The last two types were classified together as the non-IRG group. The meta-analysis included 27 studies with 50 cohorts incorporating 1260 patients. The median age of the incorporated patients was 61.4 years (range, 51-73 years), and 68.9% were male. The operations were performed for the treatment of acute aortic dissection in 82.3%. The pooled overall 30-day mortality rate varied by device type; IRG devices had a mean rate of all-cause mortality of 9.71%, whereas non-IRG devices were associated with a significantly (I 2 ¼ 15.78%; P for Cochrane Q test < .19) lower rate of death (1.47%). The pooled mean aortic cross-clamping time was 35.83 minutes. Metaregression showed that the performance of two-sided anastomosis with the IRG device significantly decreased the aortic cross-clamping time. However, a successful two-sided ringed anastomosis was performed in approximately half of the cases.Conclusions: Taking into account that the majority of operations were performed for the treatment of acute aortic dissection, AADs had a relatively low rate of 30-day mortality. Despite the observed heterogeneity in study protocols and the small sample size in the non-IRG group, the non-IRG group presented with the lowest 30-day mortality rate. Specific device-related complications between the different device types need further investigation.

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Section: Aad Typesmentioning

confidence: 99%

Section: Description Of Studiesmentioning

confidence: 99%

Α systematic review and meta-analysis of the efficacy of aortic anastomotic devices

Manolesou

Papaioannou

Georgiopoulos

et al. 2019

Journal of Vascular Surgery

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“…Currently, cardiothoracic surgery cases that require vascular anastomoses are performed using a hand-sewn technique. Some of the literature has evaluated the possibility of using a circular end-to-end anastomosis stapler for prosthetic graft to graft anastomoses, 1 but that still remains rarely used and was not described for primary vascular anastomoses.…”

mentioning

confidence: 99%

Commentary: Interesting…maybe not ready for prime time?

Chang

2021

JTCVS Techniques

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Stapled aortic graft-to-graft anastomoses: Is automation optimization?

Kilic

Atluri

2016

The Journal of Thoracic and Cardiovascular Surgery

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The design, functionality, and versatility of surgical stapling devices have evolved over the past several decades and have led to more widespread use in a variety of clinical scenarios. In addition to being used as an instrument for resection, staplers are increasingly being used for anastomoses. In this article, Idrees and colleagues 1 present their experience in 44 patients undergoing prosthetic aortic graft-to-graft anastomoses using an automated circular stapler. The authors report excellent technical outcomes related to the anastomosis: No early or late anastomotic bleeds, strictures, or pseudoaneurysms at 2-year follow-up.In cardiac surgery, the use of staplers for anastomoses admittedly lags behind other surgical fields such as gastrointestinal surgery where stapled anastomoses are common. The authors should be congratulated on applying this technology in a novel manner and achieving favorable outcomes. This experience will hopefully serve as a platform to evaluate the utility of automated staplers in native aorta-to-graft anastomoses. The use of buttressed staplers to reinforce the suture line in such cases may be prudent.A question that arises is the generalizability of these outcomes to other surgeons. Technical issues including kinking, size mismatching, narrowing, or tearing related to mishandling of the instrument or faulty execution of the steps are potential pitfalls, particularly with surgeons who may not be familiar with the end-to-end anastomosis stapler. These issues can, of course, also happen with a hand-sewn anastomosis. It is also unclear how much time would actually be saved by using the stapler. Many aortic surgeons can sew a graft-to-graft anastomosis quite rapidly, and placing pursestrings, engaging the components of the stapler, firing the stapler, and placing reinforcement stitches may take at least a few minutes, particularly with someone who is not familiar with this technique. In our personal

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Outcomes after aortic graft-to-graft anastomosis with an automated circular stapler: A novel approach

Abstract: Use of an end-to-end anastomotic automated circular stapler is safe, effective, and durable in performing graft-to-graft anastomoses during complex thoracic aortic surgery. Further evaluation and refinement of this technique are warranted.

Cited by 3 publications

References 15 publications

Α systematic review and meta-analysis of the efficacy of aortic anastomotic devices

Α systematic review and meta-analysis of the efficacy of aortic anastomotic devices

Commentary: Interesting…maybe not ready for prime time?

Stapled aortic graft-to-graft anastomoses: Is automation optimization?

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