Novel proximal and distal anastomotic devices for coronary artery bypass surgery

Abstract

THE CURRENT LITERATURE describes many varied experimental and clinical applications of minimally invasive techniques to enhance outcomes after coronary artery bypass grafting (CABG). Many techniques facilitating anastomotic procedures are described, but long-term data supporting improved patency rates, efficiency of surgical technique, and outcomes are limited. The growing need for minimally invasive procedures and means of reducing the complexity of endoscopic suturing will be the impetus that drives the development and implementation of such anastomotic devices. Applications of simultaneous suturing, stapling, clipping, stenting, and sealing devices have provided insight toward the development of clinically acceptable procedures to facilitate positive outcomes in minimally invasive CABG surgery. Proximal anastomotic devices not only decrease operative time but also allow the surgeon to avoid using a partial occlusion clamp on the ascending aorta during CABG.1 Successful reports of an aortic anastomotic device (AAD) for sutureless anastomosis to the proximal aorta of saphenous vein grafts without aortic manipulation2,3 may provide the technologic basis to pursue distal anastomotic devices in coronary surgery. However, applying such techniques to create distal anastomoses may prove more difficult and require development of unique technologies; robotic assistance toward totally endoscopic CABG makes these goals more challenging. The ideal distal anastomotic device would have applicability to all potential conduits with interchangeable proximal/distal order and a safe bailout in the case of device malfunction.4 The ability to decrease operative time, create superb anastomoses without technical imperfection, and improve long-term patency rates lends excitement to the developing frontier of distal anastomotic devices in minimally invasive CABG surgery. The objective of this review is to compare the existing devices and provide a basis for continued development of novel anastomotic devices. The anesthetic implications will be considered.