The St Jude Medical symmetry aortic connector system for proximal vein graft anastomoses in coronary artery bypass grafting

Eckstein, Friedrich S.; Bonilla, Luis F.; Englberger, Lars; Immer, Franz F.; Berg, Todd; Schmidli, Jürg; Carrel, Thierry

doi:10.1067/mtc.2002.119695

Cited by 66 publications

(38 citation statements)

References 12 publications

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“…The flow waveforms were thus characterized by the peak Reynolds number of 5,495, mean Reynolds number of 1,054, and Womersley number of 17.8, based on the diameter of aorta. Based on in-vivo measurements [8], the mean flow rate of the graft was assumed to be 50 ml/min. The flow at the outlets of coronary artery and aorta were assumed to be fully developed with flow rate ratios of Q 4 /Q 1 = 1.04% and Q 2 / Q 1 = 98.96% within the cycle respectively.…”

Section: Boundary Conditionsmentioning

confidence: 99%

Numerical investigation and identification of susceptible sites of atherosclerotic lesion formation in a complete coronary artery bypass model

Zhang

Chua

Ghista

et al. 2008

Med Biol Eng Comput

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As hemodynamics is widely believed to correlate with anastomotic stenosis in coronary bypass surgery, this paper investigates the flow characteristics and distributions of the hemodynamic parameters (HPs) in a coronary bypass model (which includes both proximal and distal anastomoses), under physiological flow conditions. Disturbed flows (flow separation/reattachment, vertical and secondary flows) as well as regions of high oscillatory shear index (OSI) with low wall shear stress (WSS), i.e., high-OSI-and-low-WSS and low-OSI-and-high-WSS were found in the proximal and distal anastomoses, especially at the toe and heel regions of distal anastomosis, which indicate highly suspected sites for the onset of the atherosclerotic lesions. The flow patterns found in the graft and distal anastomoses of our model at deceleration phases are different from those of the isolated distal anastomosis model. In addition, a huge significant difference in segmental averages of HPs was found between the distal and proximal anastomoses. These findings further suggest that intimal hyperplasia would be more prone to form in the distal anastomosis than in the proximal anastomosis, particularly along the suture line at the toe and heel of distal anastomosis.

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Section: Boundary Conditionsmentioning

confidence: 99%

Numerical investigation and identification of susceptible sites of atherosclerotic lesion formation in a complete coronary artery bypass model

Zhang

Chua

Ghista

et al. 2008

Med Biol Eng Comput

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“…Despite initial promising reports, [15][16][17] several other case series have also reported early vein graft closures with the Symmetry device. [7][8][9][10][11][12] Cavendish et al reported a series of 121 CABG patients with Symmetry implants, of which 5 presented with an acute coronary syndrome 2 to 5 months after operation.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Outcomes of the Symmetry Vein Graft Anastomosis Device

et al. 2006

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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.

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“…Emerging reports have established safety of this device and overall patency rates appear to be equivalent to historic suture-mediated anastomosis control, although large randomized trials are lacking. Early bypass graft failures have been reported, with few patients requiring redo CABG [3,4]. We report cases of early ostial saphenous vein graft stenosis associated with the use of the Symmetry connector successfully revascularized by percutaneous intervention and stenting.…”

Section: Introductionmentioning

confidence: 94%

Early ostial saphenous vein graft stenosis associated with the use of Symmetry sutureless aortic proximal anastomosis device: Successful percutaneous revascularization

Cline

Guduvalli

Kalaria

2004

Cathet Cardio Intervent

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A recent advance in technology permits the creation of sutureless proximal aortic anastomosis during coronary artery bypass graft surgery. This new tool has significant potential benefit by minimizing aortic manipulation with subsequent reduction in neuroembolization. Implantation of a nitinol-based proximal aortic connector (Symmetry) has a potential to elicit intimal hyperplastic reaction analogous to restenosis after coronary stent placement. We report cases of early vein graft stenosis in association with the use of the Symmetry device. Three patients suffered from severe ostial stenosis within 6 months of bypass surgery with symptomatic presentation. Of these three patients, two underwent successful percutaneous revascularization. Fluoroscopic star-shaped appearance of the metallic Symmetry allows device recognition during angiography. We review current data regarding graft patency with the use of Symmetry device and discuss technical issues to address specific problems during percutaneous revascularization.

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The St Jude Medical symmetry aortic connector system for proximal vein graft anastomoses in coronary artery bypass grafting

Cited by 66 publications

References 12 publications

Numerical investigation and identification of susceptible sites of atherosclerotic lesion formation in a complete coronary artery bypass model

Numerical investigation and identification of susceptible sites of atherosclerotic lesion formation in a complete coronary artery bypass model

Long-Term Outcomes of the Symmetry Vein Graft Anastomosis Device

Early ostial saphenous vein graft stenosis associated with the use of Symmetry sutureless aortic proximal anastomosis device: Successful percutaneous revascularization

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