Hand-Sewn Proximal Anastomoses in Off-Pump Coronary Artery Bypass without the Need for Partial Occlusion Clamping: Experience with the Heartstring II Proximal Seal System

Abstract

Objective

To evaluate the use of the Heartstring II Proximal Seal System (HPSS) in saphenous vein to aorta anastomoses in off-pump coronary artery bypass (OPCAB).

Methods

The HPSS consists of an aortic cutter and a proximal seal system. A prospective study was done using the HPSS to facilitate proximal hand-sewn anastomoses in OPCAB without partial occlusion clamping. Intraoperative observations, including technical success and post operative clinical data, were recorded.

Results

Using the HPSS, 84 hand-sewn proximal saphenous vein–to–aorta anastomoses were done in 50 patients. In no case was conversion to partial occlusion clamping required. After deployment of the HPSS, operator evaluation showed acceptable hemostasis in 83 of the grafts. One graft required redeployment of a second HPSS. Each bypass graft was evaluated using the Medtronic Medistem Flow Probe. Acceptable flow probe values were present in all grafts, and no revisions were required. The mean length of time for completion of the proximal anastomosis was 5 minutes (range, 4 to 14 minutes). Postoperative clinical evaluation showed no adverse events attributed to the use of the HPSS.

Conclusions

The use of HPSS is a safe and effective method to avoid partial occlusion clamping in hand-sewn proximal anastomoses with OPCAB.