Abstract
Background: Sutureless coronary anastomotic devices are intended to facilitate minimally invasive coronary artery bypass grafting (MICS-CABG) by easing and eventually standardizing the anastomotic technique. Within this systematic review and meta-analysis, we aim to determine patency and to evaluate safety outcomes for the sutureless anastomoses. Methods: CENTRAL, MEDLINE, and EMBASE were searched from database start till August 2021 in a predefined search strategy combining the key concepts: ‘coronary artery bypass grafting’, ‘sutureless coronary anastomoses’, and ‘hand-sewn coronary anastomoses’ by the Boolean operation ‘AND’. Study characteristics, patient demographics, interventional details, and all available outcome data were extracted. A meta-analysis was performed on patency at longest follow-up. Safety outcomes were presented. Results: A total of eleven trials towards six sutureless anastomotic devices were included, comprising 3724 patients (490 sutureless and 3234 hand-sewn). There was no significant difference in patency at a mean follow-up duration of 546.3 (range 1.5–2691) days, with a risk ratio of 0.77 (95% CI 0.55–1.06). MACE was reported in 4.5% sutureless and 3.9% hand-sewn patients, including all-cause mortality (resp. 1.3 vs. 1.9%), myocardial infarction (resp. 1.6 vs. 1.7%), and coronary revascularization (resp. 1.8 vs. 0.5%). Incomplete hemostasis occurred in 24.8% of the sutureless anastomoses. Intra-operative device failure forced conversion to hand-sewn or redo-anastomosis in 5.8% of the sutureless cases. Conclusion: Based on the systematic review and meta-analysis including six devices, we conclude that sutureless coronary anastomotic devices appear safe and effective when used by well-trained and dedicated surgical teams.
Highlights
Coronary artery bypass grafting (CABG) is one of the most frequently performed procedures within the field of cardiothoracic surgery, technical innovation seems to have virtually no place
A systematic literature search was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [10]
Three trials were subsequently excluded since endpoints did not match this systematic review and/or no ethical committee approval was stated
Summary
Coronary artery bypass grafting (CABG) is one of the most frequently performed procedures within the field of cardiothoracic surgery, technical innovation seems to have virtually no place. Full sternotomy and cardiopulmonary bypass still predominate CABG cases, even though serious side effects are extensively reported These effects include, but are not limited to, sternal dehiscence or infection, cerebrovascular events, systemic inflammatory reaction with eventual end-organ failure, and coagulation disorders [1,2]. Sutureless coronary anastomotic devices are intended to facilitate minimally invasive coronary artery bypass grafting (MICS-CABG) by easing and eventually standardizing the anastomotic technique. Within this systematic review and meta-analysis, we aim to determine patency and to evaluate safety outcomes for the sutureless anastomoses. MACE was reported in 4.5% sutureless and 3.9% hand-sewn patients, including all-cause mortality Conclusion: Based on the systematic review and meta-analysis including six devices, we conclude that sutureless coronary anastomotic devices appear safe and effective when used by well-trained and dedicated surgical teams
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
