Invited commentary

Abstract

In an effort to reduce the complication rate of coronary artery bypass surgery, all aortic manipulations have to be critically analyzed and reevaluated. The use of semiautomated anastomosis devices accomplishes the creation of an aorto-to-graft anastomosis without a side-biting aortic clamp.Watanabe et al describe the use of radial arteries instead of vein grafts for mechanical aortic graft connection with the St. Jude Medical Aortic Connector in CABG patients. Every surgeon who has used the Aortic Connector in vein grafts in the past might have thought of the possibility to use it in radial arteries or other arterial grafts also. These other surgeons were well advised not to use it yet for the radial artery, although the connector is feasible technically. The radial artery is a muscular artery and is highly at risk for vessel wall spasm, which might cause a string phenomenon. Therefore, when harvesting and storing the radial artery, exceptional care and delicate handling is mandatory to prevent spasm. It seems rather rough to pull a metallic transfer sheath as well as the delivery tool through this “vulnerable” artery, as is necessary when using it on the Symmetry aortic Connector. To date, the preclinical and clinical work done with the St. Jude Medical Symmetry Aortic Connector System has been limited to saphenous vein grafts only. There are differences in the mechanical and physiologic properties between vein and arterial grafts that make evaluation important. The preclinical testing of compatibility of these devices with arterial grafts should be a must before these devices are introduced into a clinical setting.With the St. Jude Medical second generation aortic connector the use of arterial grafts has been studied in an animal model (unpublished data) with acceptable results. With this new instrument, mechanical connector manipulation of the radial artery is definetively minimized, as the device is loaded from the proximal end of the artery. Therefore there is no need for the arterial graft to be skeletonized. Additionally, studies on the use of these devices in a clinical setting are important before adopting this technique for total arterial revascularization. In an effort to reduce the complication rate of coronary artery bypass surgery, all aortic manipulations have to be critically analyzed and reevaluated. The use of semiautomated anastomosis devices accomplishes the creation of an aorto-to-graft anastomosis without a side-biting aortic clamp. Watanabe et al describe the use of radial arteries instead of vein grafts for mechanical aortic graft connection with the St. Jude Medical Aortic Connector in CABG patients. Every surgeon who has used the Aortic Connector in vein grafts in the past might have thought of the possibility to use it in radial arteries or other arterial grafts also. These other surgeons were well advised not to use it yet for the radial artery, although the connector is feasible technically. The radial artery is a muscular artery and is highly at risk for vessel wall spasm, which might cause a string phenomenon. Therefore, when harvesting and storing the radial artery, exceptional care and delicate handling is mandatory to prevent spasm. It seems rather rough to pull a metallic transfer sheath as well as the delivery tool through this “vulnerable” artery, as is necessary when using it on the Symmetry aortic Connector. To date, the preclinical and clinical work done with the St. Jude Medical Symmetry Aortic Connector System has been limited to saphenous vein grafts only. There are differences in the mechanical and physiologic properties between vein and arterial grafts that make evaluation important. The preclinical testing of compatibility of these devices with arterial grafts should be a must before these devices are introduced into a clinical setting. With the St. Jude Medical second generation aortic connector the use of arterial grafts has been studied in an animal model (unpublished data) with acceptable results. With this new instrument, mechanical connector manipulation of the radial artery is definetively minimized, as the device is loaded from the proximal end of the artery. Therefore there is no need for the arterial graft to be skeletonized. Additionally, studies on the use of these devices in a clinical setting are important before adopting this technique for total arterial revascularization.