A new clip device for the construction of vascular interrupted anastomoses in congenital cardiac surgery.

Abstract

Many different mechanical vascular anastomotic devices have been developed recently, mostly rigid stenting mechanisms applicable only in coronary artery bypass grafting surgery. U-Clips, however, allow the precise construction of any vascular interrupted anastomosis, preserving pulsatility and perhaps growth potential. We report the first use worldwide of U-Clips for congenital cardiac surgery in 10 pediatric patients (mean age, 2.3 +/- 1.7 years). The operations took place between July 2001 and July 2002 for coarctation repair (3 patients), Glenn shunt (5 patients), Blalock-Taussig shunt (1 patient), and arterial switch (1 patient). Device handling, primary hemostasis, and patency were excellent, and no device-related complications occurred. Because of the learning curve, aortic cross-clamp times were significantly longer for the repair of coarctation with U-Clips than with the running-suture technique (21.7 +/- 2.3 minutes versus 14.4 +/- 2 minutes; P = .012). Postoperative recoveries were uneventful in all patients except for a baby with pulmonary atresia with intact ventricular septum, who died after 62 days. After a mean follow-up period of 11.9 +/- 4.4 months, echocardiographic controls of all anastomoses showed nonturbulent flow without any restriction. The U-Clip device may be a useful adjunct in congenital cardiac surgery for facilitating the creation of interrupted vascular anastomoses. Further evaluation is warranted for determining the long-term benefits of these devices with respect to growth preservation and restenosis.