Thorac Cardiovasc Surg 2013; 61(08): 669-675
DOI: 10.1055/s-0032-1311539
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

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

Niels J. Verberkmoes
1   Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands
,
M. Mostafa Mokhles
2   Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
,
Sander Bramer
1   Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands
,
Albert H.M. van Straten
1   Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands
,
Joost F. ter Woorst
1   Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands
,
Jos G. Maessen
3   Department of Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht—CARIM, Maastricht University Medical Center—MUMC, Maastricht, The Netherlands
,
Eric Berreklouw
1   Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands
› Author Affiliations
Further Information

Publication History

20 November 2011

09 January 2012

Publication Date:
08 June 2012 (online)

Abstract

Background Several short-term and midterm follow-up studies of the Symmetry aortic connector system showed controversial results. The objective of the present study was assessing the long-term clinical outcome of patients operated with the Symmetry device and to compare the results with hand-sewn control patients.

Methods A retrospective case–control study of 156 (46 cases, 110 controls) consecutive patients, that underwent off-pump coronary revascularization, between January 2001 and December 2004, was conducted. Study endpoints were all-cause mortality, coronary reintervention and postoperative stroke.

Results There was no difference in survival between cases and controls (89.1 vs. 82.4%, p = 0.27) after 8 years of follow-up. No significant difference could be detected between cases and controls with respect to overall long-term coronary reintervention free survival (82.6 vs. 88.9%, p = 0.41) and freedom from coronary reintervention due to proximal vein graft failure (91.3 vs. 96.3%, p = 0.24). The use of Symmetry device could not be identified as independent risk-factor of coronary reintervention due to proximal vein graft failure (p = 0.25). Furthermore, postoperative stroke rates were comparable between cases and controls (0.0 vs. 0.9%, p = 1.00).

Conclusion This study suggests that the use of the Symmetry Bypass Connector was not associated with adverse outcome in terms of overall survival, long-term coronary reintervention free survival, freedom from reintervention due to proximal vein graft failure and postoperative stroke.

 
  • References

  • 1 Bergmann P, Meszaros K, Huber S , et al. Forty-one-month follow-up of the Symmetry aortic connector system for proximal venous anastomosis. J Thorac Cardiovasc Surg 2007; 134 (1) 23-28
  • 2 Antona C, Scrofani R, Lemma M , et al. Assessment of an aortosaphenous vein graft anastomotic device in coronary surgery: clinical experience and early angiographic results. Ann Thorac Surg 2002; 74 (6) 2101-2105
  • 3 Kitamura H, Okabayashi H, Hanyu M , et al. Early and midterm patency of the proximal anastomoses of saphenous vein grafts made with a symmetry aortic connector system. J Thorac Cardiovasc Surg 2005; 130 (4) 1028-1031
  • 4 Verma S, Fedak PW, Ko L , et al. Evaluation of a novel sutureless anastomotic connector: from endothelial function to mid-term clinical and angiographic follow-up. J Thorac Cardiovasc Surg 2003; 126 (5) 1555-1560
  • 5 Watanabe G, Takemura H, Tomita S, Nagamine H, Kamiya H, Kanamori T. Skeletonized radial artery graft with the St. Jude Medical Symmetry Bypass System (aortic connector system). Ann Thorac Surg 2004; 77 (5) 1550-1552 , discussion 1552
  • 6 Wiklund L, Bugge M, Berglin E. Angiographic results after the use of a sutureless aortic connector for proximal vein graft anastomoses. Ann Thorac Surg 2002; 73 (6) 1993-1994
  • 7 Bergsland J, Hol PK, Lingås PS , et al. Intraoperative and intermediate-term angiographic results of coronary artery bypass surgery with Symmetry proximal anastomotic device. J Thorac Cardiovasc Surg 2004; 128 (5) 718-723
  • 8 Katariya K, Yassin S, Tehrani HY, Lombardi P, Masroor S, Salerno TA. Initial experience with sutureless proximal anastomoses performed with a mechanical connector leading to clampless off-pump coronary artery bypass surgery. Ann Thorac Surg 2004; 77 (2) 563-567 , discussion 567–568
  • 9 Nishizaki K, Seki T. Early results of aortic connector system for proximal anastomosis of the saphenous vein graft. Ann Thorac Cardiovasc Surg 2005; 11 (2) 98-103
  • 10 Toyama M, Usui A, Abe T, Yoshikawa M, Akita T, Ueda Y. Early clinical results of St. Jude Medical Symmetry aortic connector. J Artif Organs 2005; 8 (2) 95-99
  • 11 Traverse JH, Mooney MR, Pedersen WR , et al. Clinical, angiographic, and interventional follow-up of patients with aortic-saphenous vein graft connectors. Circulation 2003; 108 (4) 452-456
  • 12 Quigley RL. Severe ostial saphenous vein graft disease leading to acute coronary syndromes after proximal aorto-saphenous anastomoses with the symmetry bypass connector device. J Am Coll Cardiol 2004; 44 (5) 1140-1141 , author reply 1141–1142
  • 13 Cavendish JJ, Penny WF, Madani MM , et al. Severe ostial saphenous vein graft disease leading to acute coronary syndromes following proximal aorto-saphenous anastomoses with the symmetry bypass connector device: is it a suture device or a “stent”?. J Am Coll Cardiol 2004; 43 (1) 133-139
  • 14 Bergsland J, Hol PK, Lingaas PS, Lundblad R , et al. Long-term follow-up of patients operated with the symmetry proximal connector device. Innovations (Phila). 2011 Jan, 6 (1): 15–16
  • 15 Sabik III JF, Blackstone EH, Gillinov AM, Smedira NG, Lytle BW. Occurrence and risk factors for reintervention after coronary artery bypass grafting. Circulation 2006; 114 (1, Suppl) I454-I460
  • 16 Kachhy RG, Kong DF, Honeycutt E, Shaw LK, Davis RD. Long-term outcomes of the symmetry vein graft anastomosis device: a matched case-control analysis. Circulation 2006; 114 (1, Suppl) I425-I429
  • 17 Puskas JD, Halkos ME, Balkhy H , et al; EPIC Trial Investigators. Evaluation of the PAS-Port Proximal Anastomosis System in coronary artery bypass surgery (the EPIC trial). J Thorac Cardiovasc Surg 2009; 138 (1) 125-132
  • 18 Mehta SR, Yusuf S, Peters RJ , et al; Clopidogrel in Unstable angina to prevent Recurrent Events trial (CURE) Investigators. Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI-CURE study. Lancet 2001; 358 (9281) 527-533