New Approaches for Vascular Anastomoses.

Increasing interest in minimally invasive cardiac surgical procedures has generated a renewed interest in facilitated methods to create vascular anastomosis. These devices, in order to be viable, must perform equally or better than sutures. An extensive review of the literature was performed on the different ways to create a mechanical vascular anastomosis. The experience of the authors with the development of a family of connectors (The Symmetry Bypass System; St. Jude Medical, Minneapolis, MN) is presented. The Aortic Connector System (St. Jude Medical) has undergone extensive animal testing with 30-, 90-, and 180-day follow-up. Over 250 human implants have been performed successfully. Preliminary animal studies with the stainless steel coronary connector are also presented. The creation of a facilitated mechanical vascular anastomosis should not compromise quality or patency rates, and produce at least the same results as those obtained with standard suturing techniques. These devices dramatically reduce the time to perform an anastomosis and eliminate the need for aortic clamping and cardiopulmonary bypass. These advantages should result in a significant reduction in surgical complications, and may facilitate a move to true endoscopic and/or percutaneous bypass.