Minimizing aortic manipulation during OPCAB using the symmetry aortic connector system for proximal vein graft anastomoses Friedrich S Eckstein, MD,

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Presentation transcript:

Minimizing aortic manipulation during OPCAB using the symmetry aortic connector system for proximal vein graft anastomoses Friedrich S Eckstein, MD, Luis F Bonilla, MD, Lars Englberger, MD, Edouard Stauffer, MD, Todd A Berg, Jürg Schmidli, MD, Thierry P Carrel, MD The Annals of Thoracic Surgery Volume 72, Issue 3, Pages S995-S998 (September 2001) DOI: 10.1016/S0003-4975(01)02965-4

Fig 1 The external diameter of the graft is assessed to choose the most adequate size of the different connector systems. The special measuring bar is separated in 0.25-mm increments. The Annals of Thoracic Surgery 2001 72, S995-S998DOI: (10.1016/S0003-4975(01)02965-4)

Fig 2 The vein over the hooks of the connector and already pierced through the connector hooks. The outer struts of the connector are not yet retracted by the green part of the release tube that will be screwed in the release handle. The Annals of Thoracic Surgery 2001 72, S995-S998DOI: (10.1016/S0003-4975(01)02965-4)

Fig 3 The aortic connector system is loaded and ready for deployment with the nose cone on top to secure the internal struts and the vein connector hooks while delivering. The Annals of Thoracic Surgery 2001 72, S995-S998DOI: (10.1016/S0003-4975(01)02965-4)

Fig 4 Schematic inside view of the aorta: The loaded aortic connector system is inserted into the aorta and the internal struts of the aortic connector are already deployed. A small rim of the vein (brown—see arrow) is everted onto the intimal layer of the aorta covering most of the metallic surface of the connector. The external struts are still in the delivery sheath. The Annals of Thoracic Surgery 2001 72, S995-S998DOI: (10.1016/S0003-4975(01)02965-4)

Fig 5 Schematic outside view of the aorta: Pulling back the handle with the delivery sheath perpendicular to the anastomosis deploys the external struts and removes all components from the inside of the vein graft. The Annals of Thoracic Surgery 2001 72, S995-S998DOI: (10.1016/S0003-4975(01)02965-4)

Fig 6 Intraoperative view in a patient who received two proximal vein graft anastomoses on the aorta with the aortic connector system. The left vein is guided over the pulmonary artery to the obtuse marginal branch, the right vein is guided between the right auricle and ventricle to the posterior descending branch. The Annals of Thoracic Surgery 2001 72, S995-S998DOI: (10.1016/S0003-4975(01)02965-4)

Fig 7 Histologic examination of a revealed plug shows sharply cut borders and no structure displacements of the aortic layers (Hematoxylin and eosin; ×5 before 17% reduction). The Annals of Thoracic Surgery 2001 72, S995-S998DOI: (10.1016/S0003-4975(01)02965-4)