Results with the Heartstring anastomotic device in patients with diseased ascending aorta

Biancari, Fausto; Mosorin, Martti; Lahtinen, Jarmo; Heikkinen, Jouni; Rasinaho, Elsi; Anttila, Vesa; Lepojärvi, Martti; Juvonen, Tatu

doi:10.1080/14017430600849211

Cited by 13 publications

(9 citation statements)

References 8 publications

(8 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Several authors have suggested that, once aortic atherosclerosis is identified, alternative strategies should be considered to prevent mobilization of aortic atheroma. These strategies include techniques such as groin or subclavian placement of the aortic cannulas, fibrillatory arrest without aortic cross-clamping, use of a single cross-clamp technique, modifying the placement of proximal anastomosis, all-arterial revascularization, or use of T and Y grafts [8,10,17,22]. Epiaortal ultrasound has been established as the technique of choice to screen the aorta for atherosclerosis and is particularly recommended for older patients.…”

Section: Discussionmentioning

confidence: 99%

“…To overcome this problem, we routinely conducted HEARTSTRING supported proximal anastomosis during OPCAB procedures following the clampless principle. Several authors have reported their first clinical experiences with the HEARTSTRING system [10-13]; our observations of 412 consecutive patients (542 proximal anastomosis) were made with particular regard to stroke rates.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Minimizing the risk of perioperative stroke by clampless off-pump bypass surgery: a retrospective observational analysis

Hilker

Arlt

Keyser

et al. 2010

J Cardiothorac Surg

View full text Add to dashboard Cite

ObjectivesStroke is a devastating complication after coronary artery bypass grafting, occurring in 1.4% to 4.3% of patients. A major cause of stroke is cerebral embolization of aortic atheromatous debris or calcified plaques. This report analyzes the incidence of stroke in patients treated according to the clampless concept, i.e. avoiding side-clamping of the aorta, by means of off-pump coronary artery bypass surgery (OPCAB) in combination with the HEARTSTRING device.MethodsDuring a period of 43 months (2005-2008), 412 consecutive patients were treated with the above-mentioned method by one single surgeon. A minimum of one proximal aortal anastomosis was performed in each patient. Altogether, 542 proximal anastomosis were applied, each created by means of the HEARTSTRING device.ResultsThe mean age of patients was 67+9.7 years, the predicted mortality 5.2% (logistic EuroSCORE) and the observed mortality 1.9%. Histories of preoperative neurological disorders or cerebrovascular diseases were documented in 15% of patients. The overall incidence of postoperative stroke was 0.48% in contrast to 1.3% according to the stroke risk score.ConclusionsIn accordance to previously published data, our results show that avoiding aortic side-clamping during OPCAB reduces postoperative stroke rates. The HEARTSTRING device is a safe option for creating proximal aortic anastomosis.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Minimizing the risk of perioperative stroke by clampless off-pump bypass surgery: a retrospective observational analysis

Hilker

Arlt

Keyser

et al. 2010

J Cardiothorac Surg

View full text Add to dashboard Cite

show abstract

“…The search in Clinicaltrials.gov yielded one study on Heartstring, which is still recruiting since 2006 and its results are, to our knowledge, still unpublished. We were able to retrieve data on the use of the Heartstring anastomotic device in coronary artery bypass grafting (CABG) from eight studies [13][14][15][16][17][18][19][20]. Among these studies, only two were of prospective nature.…”

Section: Resultsmentioning

confidence: 98%

Meta-analysis on the use of the Heartstring anastomotic device to prevent stroke in patients undergoing off-pump coronary artery bypass grafting

Biancari

Yli-Pyky

2011

European Journal of Cardio-Thoracic Surgery

Self Cite

View full text Add to dashboard Cite

The results of this meta-analysis suggest that the risk of stroke after OPCAB may not be markedly reduced by the use of Heartstring device. On the other hand, a rather low rate of stroke was observed among patients with diseased ascending aorta indicating its potential value in these patients. Most of studies included in this meta-analysis were of poor methodological quality, and properly conducted prospective studies are needed to get more conclusive results on the safety and efficacy of Heartstring anastomosis device.

show abstract

“…27 The HEARTSTRING device may prove to be a useful option because it avoids aortic clamping, can be used in the diseased aorta, and does not require circulatory arrest. 28 Using this anastomotic device does incur an extra cost of approximately $500 per anastomosis. In addition, the question remains whether deploying this device inside a severely diseased aorta will liberate embolic debris.…”

Section: Abbreviations and Acronymsmentioning

confidence: 99%

Clampless technique during coronary artery bypass grafting for proximal anastomoses in the hostile aorta

Salenger

Rodriquez

Efird

et al. 2013

The Journal of Thoracic and Cardiovascular Surgery

View full text Add to dashboard Cite

The incidence of stroke in patients undergoing coronary artery bypass grafting increases sharply in the face of significant atherosclerotic disease of the ascending aorta. We use a technique that allows full revascularization for this cohort of patients, while minimizing cerebral embolic risk. Methods: Intraoperative epiaortic ultrasound was used to screen for moderate or severe atherosclerotic disease of the ascending aorta and to precisely identify safe areas for cannulation and proximal anastomoses. By using a mildly hypothermic fibrillating technique, distal revascularization was then performed without clamping the aorta. Proximal anastomoses were accomplished under brief periods of circulatory arrest. Results: We routinely use this technique and examined our results in 71 consecutive patients found to have grade 3 or greater atherosclerotic plaque of the ascending aorta. This represented approximately 10.0% of our total population who underwent coronary artery bypass grafting over a 32-month period from January 2007 to September 2009. One patient (1.4%) had a mild stroke that resolved, and there were no other neurologic complications. Conclusions: We have found that clampless fibrillating heart surgery with circulatory arrest for proximal anastomoses is a safe and effective technique for revascularizing patients with significant ascending aortic disease who are at high risk for cerebral embolic complications.

show abstract

Results with the Heartstring anastomotic device in patients with diseased ascending aorta

Abstract: The use of the Heartstring anastomotic device should be considered in high-risk patients with diseased ascending aorta requiring a prompt myocardial revascularization, whenever there is a place to safely insert this device into the ascending aorta.

Cited by 13 publications

References 8 publications

Minimizing the risk of perioperative stroke by clampless off-pump bypass surgery: a retrospective observational analysis

Minimizing the risk of perioperative stroke by clampless off-pump bypass surgery: a retrospective observational analysis

Meta-analysis on the use of the Heartstring anastomotic device to prevent stroke in patients undergoing off-pump coronary artery bypass grafting

Clampless technique during coronary artery bypass grafting for proximal anastomoses in the hostile aorta

Contact Info

Product

Resources

About