Initial clinical experience with a new end graft holder for anastomosis in coronary surgery.

OBJECTIVE: We assessed the feasibility and effectiveness of a novel end graft holder for coronary artery bypass grafting (CABG) and evaluated anastomotic patency and early clinical results. METHODS: The end graft holder was applied to 45 consecutive patients. Operative characteristics were off-pump CABG in 22.2%, emergency in 28.9%, and concomitant cardiac surgery in 13.3%. RESULTS: The device was used safely without graft injury or inadequate gripping on grafts. Postoperative angiography showed that the patency rate of distal anastomosis was 96.7% (arterial, 100%; venous, 94%). All proximal aortic and composite graft anastomoses were patent without stenosis. The rate of 30-day major adverse cardiac and cerebrovascular events was 13.3% (operative deaths, 3; repeated CABG, 1; percutaneous coronary arterial intervention, 1; and cerebral infarction, 1). None of the elective patients died during hospitalization. CONCLUSION: Our initial clinical experience demonstrated that the new end graft holder was safe, reliable, and effective during CABG. The excellent fixation and visualization of the graft with the device might be particularly beneficial for off-pump CABG or for teaching trainees.

Graft-to-coronary-artery shunt during off-pump coronary artery bypass grafting.

We have developed a simple technique for temporary shunt from the saphenous vein graft to the coronary artery during off-pump coronary anastomosis. The ends of a 2-mm diameter tube were inserted into the distal end of the saphenous vein graft in which proximal anastomosis had been established and into the right coronary artery crux. Blood flow sufficient to maintain adequate hemodynamics was obtained through the shunt tube while suturing around the tube. We successfully employed this technique in 5 patients with acute coronary syndrome. We suggest that this technique may represent an addition to the armamentarium for off-pump anastomosis to the right coronary artery.

Nonprosthetic surgical repair of pectus excavatum.

BACKGROUND: Previously, a method was reported to correct pectus excavatum in which a convex steel bar is inserted beneath the sternum. This method gained popularity, but a relatively high incidence of complications has been reported. We review our experience of nonprosthetic repairs of pectus excavatum. METHODS: From 1993 through 2004, 62 patients underwent repair of pectus excavatum. Sternocostal elevation was adopted for 54 patients (11.7 +/- 8.3 years old). A part of the third or fourth to the seventh costal cartilages was resected. All of the stumps were pulled to generate tension and resutured with the sternum. Cortical osteotomy of upper sternum and introduction of exogenous material were not employed. Sternal turnover and overlap was adopted for 8 adults (24.1 +/- 9.0 years old) with severe asymmetric deformities. The sternum was cut at the level of the second or third intercostal space. The lower part of the sternum was turned over and secured in a position so that it overlapped with the upper sternum, and the stumps of cartilages were reattached to the plastron. In these procedures, the natural tension exerted by the patient's ribs is sufficient to elevate and fix the sternum. RESULTS: Mechanical ventilation was not required after emergence from anesthesia. None of the patients experienced threatening complications or required reoperation. Fifty patients (81%) were graded as excellent, and 12 patients (19%) were graded as good at 1 month after surgery. CONCLUSIONS: The procedures described here yielded excellent results with low morbidity and no mortality, and produced high patient satisfaction.

A surgical case of concomitant aneurysms of the brachiocephalic and coronary arteries.

Brachiocephalic artery aneurysm with concomitant coronary artery aneurysm is rare. We describe a case of a patient with a history of prosthetic graft placement following resection of an abdominal aortic aneurysm and was subsequently found to have a brachiocephalic artery aneurysm. After surgical correction of the brachiocephalic aneurysm, postoperative coronary arteriography demonstrated coronary artery aneurysms, and the patient subsequently underwent coronary artery bypass grafting (CABG).

Replacement of the aortic root and ascending aorta using a freestyle valve and woven Dacron graft.

We contrived a surgical technique for the purpose of improving recent results. From April 1998 to June 2001, 24 patients (aged 60 to 81 years, mean age 71.0 +/- 4.8 years; 11 men, 13 women) underwent replacement of the aortic root and the ascending aorta electively using a Freestyle stentless valve with woven Dacron graft at our institution. The aortic root was replaced first, the distal side of the Dacron graft was then anastomosed, and finally, the proximal side was anastomosed with the outflow of the Freestyle valve. Cardiopulmonary bypass time and cardioplegic time were 297 +/- 83 min and 210 +/- 51 min, respectively. The geometry of the ascending aorta and the diameter mismatch between the dilated ascending aorta and the outflow of the Freestyle valve were fully corrected. There were two early deaths and three late deaths; none valve-related. Postoperative aortogram showed an excellent shape. The mortality, morbidity, and clinical events after the procedure were acceptable.