The use of aortic connectors for the performance of proximal anastomosis in beating heart surgery was initially embraced as a result of the ease of performance and the ability to avoid the placement of clamps on the aorta. Concerns regarding the failure rates of these devices have prompted most surgeons to abandon their use. We review the early clinical course of the 348 proximal anastamoses performed with the St. Jude Symmetry Aortic Conector (SJAC) device in our beating heart CABG program.
A review of the medical records of all patients who underwent placement of SJAC was undertaken to evaluate for the presence of recurrent angina, myocardial infarction, other cardiac event, or intervention in the cardiac catheterization lab.
Proximal anastamotic failure occurred in 13/124 (10.48%) patients with 22/348 (6.3%) of the grafts requiring intervention in the catheterization lab at a mean interval of 9.2 months (range 0.5-18months). Overall mortality for the group of patients was 3/124 (2.42%) patients and the operative mortality was 2/124 (1.6%). There were no deaths directly attributable to SJAC failure. There were no strokes in any of the SJAC patients.
There is a risk of early graft failure with the use of the SJAC. These failures can frequently be managed in the cardiac catheterization lab with standard catheter-based interventions. The late failure rate of these devices remains poorly defined and further study of those patients with implanted SJAC should occur.
The introduction of SJAC allowed for performance of beating heart CABG with a lower incidence of stroke; however, this benefit appears to have been achieved at the cost of an increased early proximal anastamotic failure rate. The fate of spahenous vein grafts that have undergone intervention is known to be less satisfactory than unintervened grafts and it is anticipated that the higher than expected early graft failure rate will translate to poorer long term saphenous vein graft patencies.
Douglas Miller, None.