Download PDF
Thorac Cardiovasc Surg
DOI: 10.1055/s-0044-1786986
Original Cardiovascular

Outcomes of 881 Consecutive Coronary Artery Bypass Graft Patients Using Heartstring Device

Kentaro Amano
1   Department of Cardiovascular Surgery, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
,
Yoshiyuki Takami 
1   Department of Cardiovascular Surgery, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
,
Atsuo Maekawa
1   Department of Cardiovascular Surgery, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
,
Koji Yamana
1   Department of Cardiovascular Surgery, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
,
Kiyotoshi Akita
1   Department of Cardiovascular Surgery, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
,
Kazuki Matsuhashi
1   Department of Cardiovascular Surgery, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
,
Wakana Niwa
1   Department of Cardiovascular Surgery, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
,
Yasushi Takagi
1   Department of Cardiovascular Surgery, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
› Author Affiliations
› Further Information
    Permissions and Reprints All articles of this category

Abstract

Backgrounds One of the strategies to prevent stroke after coronary artery bypass grafting (CABG) may be the use of a device for proximal anastomosis without partial clamp of the ascending aorta.

Methods We retrospectively investigated early and late outcomes in consecutive 881 patients undergoing isolated CABG using Heartstring for proximal anastomosis from January 2008 to December 2022, to reveal the validity to use it. All patients underwent preoperative imaging workups to evaluate neurovascular atherosclerosis.

Results The mean age of the patients was 68.9 years, 20% were female and 13% had previous history of stroke. CABG was on-pump beating heart (52.2%) or off-pump (47.8%) with a mean number of distal anastomoses of 3.38 ± 0.93, using 1.62 ± 0.53 Heartstring devices under different aortic manipulations. In-hospital mortality was 2.0% and perioperative stroke rate was 0.9%, none of them died during hospital stay. During the follow-up period of 70 ± 47 months, the overall actuarial survival rates were 86 and 66%, and major adverse cardiac and cerebrovascular events (MACCEs)-free rates were 86 and 70% at 5 and 10 years, respectively. On multivariable analysis, risk factors for late death included male, previous history of stroke, postoperative sternomediastinitis, late new-onset stroke, and MACCEs, but did not include the perioperative stroke.

Conclusion Low stroke rate, as low as 0.9%, after CABG using Heartstring for proximal anastomosis, although under a variety of aortic manipulations, may contribute to the improved long-term prognosis.

Keywords

coronary artery bypass grafting - Heartstring - stroke - late outcomes

Ethical Statement

The institutional review board approved this retrospective study to analyze single-center data of our routine medical practice for the CABG patients, including a waiver of informed consent (HM 22-525; April 11, 2023).




Publication History

Received: 10 March 2024

Accepted: 22 April 2024

Article published online:
13 May 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Gaudino M, Angiolillo DJ, Di Franco A. et al. Stroke after coronary artery bypass grafting and percutaneous coronary intervention: incidence, pathogenesis, and outcomes. J Am Heart Assoc 2019; 8 (13) e013032
    CrossrefPubMedSearch in Google Scholar
  • 2 Jonsson K, Barbu M, Nielsen SJ. et al. Perioperative stroke and survival in coronary artery bypass grafting patients: a SWEDEHEART study. Eur J Cardiothorac Surg 2022; 62 (04) ezac025
    CrossrefPubMedSearch in Google Scholar
  • 3 Ikram A, Mohiuddin H, Zia A. et al. Does epiaortic ultrasound screening reduce perioperative stroke in patients undergoing coronary surgery? A topical review. J Clin Neurosci 2018; 50: 30-34
    CrossrefPubMedSearch in Google Scholar
  • 4 Vicol C, Oberhoffer M, Nollert G. et al. First clinical experience with the HEARTSTRING, a device for proximal anastomoses in coronary surgery. Ann Thorac Surg 2005; 79 (05) 1732-1737 , discussion 1737
    CrossrefPubMedSearch in Google Scholar
  • 5 Emmert MY, Grünenfelder J, Scherman J. et al. HEARTSTRING enabled no-touch proximal anastomosis for off-pump coronary artery bypass grafting: current evidence and technique. Interact Cardiovasc Thorac Surg 2013; 17 (03) 538-541
    CrossrefPubMedSearch in Google Scholar
  • 6 Nozdrzykowski M, Borger MA, Saeed D. Application of a clampless hemostatic device (HeartString®) for outflow graft anastomosis. Multimed Man Cardiothorac Surg 2020;2020
    PubMed
  • 7 Knol WG, Budde RPJ, Mahtab EAF, Bekkers JA, Bogers AJJC. Intimal aortic atherosclerosis in cardiac surgery: surgical strategies to prevent embolic stroke. Eur J Cardiothorac Surg 2021; 60 (06) 1259-1267
    CrossrefPubMedSearch in Google Scholar
  • 8 Halkos ME, Anderson A, Binongo JNG. et al. Operative strategies to reduce cerebral embolic events during on- and off-pump coronary artery bypass surgery: a stratified, prospective randomized trial. J Thorac Cardiovasc Surg 2017; 154 (04) 1278-1285.e1
    CrossrefPubMedSearch in Google Scholar
  • 9 Ueki C, Sakaguchi G, Akimoto T, Ohashi Y, Sato H. On-pump beating-heart technique is associated with lower morbidity and mortality following coronary artery bypass grafting: a meta-analysis. Eur J Cardiothorac Surg 2016; 50 (05) 813-821
    CrossrefPubMedSearch in Google Scholar
  • 10 Matsuhashi K, Takami Y, Maekawa A. et al. Comparison between off-pump versus on-pump beating heart coronary artery bypass grafting. Thorac Cardiovasc Surg 2024 (e-pub ahead of print)
    Thieme ConnectPubMed
  • 11 Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant 2013; 48 (03) 452-458
    CrossrefPubMedSearch in Google Scholar
  • 12 Formica F, D'Alessandro S, Messina LA. Clampless facilitated anastomosis with HEARSTRING to reduce cerebral damage during off-pump coronary bypass grafting. Don't forget it: Easy to use!. J Thorac Cardiovasc Surg 2018; 155 (05) 2021-2022
    CrossrefPubMedSearch in Google Scholar
  • 13 El Zayat H, Puskas JD, Hwang S. et al. Avoiding the clamp during off-pump coronary artery bypass reduces cerebral embolic events: results of a prospective randomized trial. Interact Cardiovasc Thorac Surg 2012; 14 (01) 12-16
    CrossrefPubMedSearch in Google Scholar
  • 14 Thourani VH, Razavi SA, Nguyen TC. et al. Incidence of postoperative stroke using the Heartstring device in 1,380 coronary artery bypass graft patients with mild to severe atherosclerosis of the ascending aorta. Ann Thorac Surg 2014; 97 (06) 2066-2072 , discussion 2072
    CrossrefPubMedSearch in Google Scholar
  • 15 Formica F, Tata G, Singh G. et al. Incidence of perioperative stroke in clampless aortic anastomosis during off-pump coronary artery bypass grafting. Heart Vessels 2018; 33 (06) 595-604
    CrossrefPubMedSearch in Google Scholar
  • 16 Saito A, Kumamaru H, Ono M, Miyata H, Motomura N. Propensity-matched analysis of a side-clamp versus an anastomosis assist device in cases of isolated coronary artery bypass grafting. Eur J Cardiothorac Surg 2018; 54 (05) 889-895
    CrossrefPubMedSearch in Google Scholar
  • 17 Saito A, Kumamaru H, Miyata H, Motomura N. Device use for proximal anastomosis on ascending aorta in off-pump coronary artery bypass grafting. Ann Thorac Surg 2021; 111 (06) 1909-1915
    CrossrefPubMedSearch in Google Scholar
  • 18 Takami Y, Masumoto H. Brain magnetic resonance angiography-based strategy for stroke reduction in coronary artery bypass grafting. Interact Cardiovasc Thorac Surg 2006; 5 (04) 383-386
    CrossrefPubMedSearch in Google Scholar
  • 19 Nates R, Arazi M, Grosman-Rimon L. et al. The routine use of preoperative non-contrast chest computerized tomography and carotid arteries Doppler prior to cardiac surgery. J Cardiothorac Surg 2022; 17 (01) 178
    CrossrefPubMedSearch in Google Scholar
  • 20 Hangler HB, Nagele G, Danzmayr M. et al. Modification of surgical technique for ascending aortic atherosclerosis: impact on stroke reduction in coronary artery bypass grafting. J Thorac Cardiovasc Surg 2003; 126 (02) 391-400
    CrossrefPubMedSearch in Google Scholar
  • 21 Kim DJ, Lee SH, Joo HC, Yoo KJ, Youn YN. Effects of a proximal seal system on neurologic outcomes of off-pump coronary artery bypass grafting. Int Heart J 2019; 60 (03) 593-600
    CrossrefPubMedSearch in Google Scholar
  • 22 Niclauss L, Colombier S, Prêtre R. Single Heartstring aortotomy for multiple off-pump venous bypass grafts. Asian Cardiovasc Thorac Ann 2015; 23 (05) 609-611
    CrossrefPubMedSearch in Google Scholar
  • 23 Tokunaga S, Tominaga N, Lee S, Masuda M. A technique to make multiple proximal anastomoses with one HEARTSTRING suture device. J Card Surg 2016; 31 (04) 206-207
    CrossrefPubMedSearch in Google Scholar
  • 24 Santos RFD, Niclauss L. First results of the single heartstring aortotomy for multiple off-pump vein grafts: a case series. Korean J Thorac Cardiovasc Surg 2020; 53 (06) 403-407
    CrossrefPubMedSearch in Google Scholar
  • 25 Reents W, Zacher M, Boergermann J. et al. Off-pump coronary artery bypass grafting and stroke-exploratory analysis of the GOPCABE trial and methodological considerations. Thorac Cardiovasc Surg 2018; 66 (06) 464-469
    Thieme ConnectPubMedSearch in Google Scholar