Forty-one-month follow-up of the Symmetry aortic connector system for proximal venous anastomosis

Bergmann, Peter; Meszaros, Katharina; Huber, Stefan; Oberwalder, Peter; Mächler, Heinrich; Schaffler, Gottfried; Rienmueller, Rainer; Rigler, Bruno

doi:10.1016/j.jtcvs.2007.02.007

« Previous Next »The Journal of Thoracic and Cardiovascular Surgery
Volume 134, Issue 1 , Pages 23-28, July 2007

Forty-one-month follow-up of the Symmetry aortic connector system for proximal venous anastomosis

Peter Bergmann, MD
- Department of Surgery, Division of Cardiac Surgery, Medical University of Graz, Austria
- Address for reprints: Peter Bergmann, MD, Division of Cardiac Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, A-8036 Graz, Austria.
Katharina Meszaros, MD
- Department of Surgery, Division of Cardiac Surgery, Medical University of Graz, Austria
Stefan Huber, MD
- Department of Surgery, Division of Cardiac Surgery, Medical University of Graz, Austria
Peter Oberwalder, MD
- Department of Surgery, Division of Cardiac Surgery, Medical University of Graz, Austria
Heinrich Mächler, MD
- Department of Surgery, Division of Cardiac Surgery, Medical University of Graz, Austria
Gottfried Schaffler, MD
- Department of Radiology, Division of Cardiac Surgery, Medical University of Graz, Austria.
Rainer Rienmueller, MD
- Department of Radiology, Division of Cardiac Surgery, Medical University of Graz, Austria.
Bruno Rigler, MD
- Department of Surgery, Division of Cardiac Surgery, Medical University of Graz, Austria

Received 29 November 2006; received in revised form 2 February 2007; accepted 7 February 2007.

Objective

Results of short- and midterm follow-up studies of the patency rate of the Symmetry aortic connector systems (St Jude Medical, Inc, Minneapolis, Minn) are controversial. Long-term follow-up studies are still lacking (so far, the longest mean follow-up period was 19 months). The aim of our study was (1) to evaluate the patency rate of this device over a longer time-period and (2) to analyze risk factors for graft occlusion.

Methods

Between November 2000 and July 2003, 76 Symmetry aortic connector systems were implanted in 42 patients. At follow-up, 24 patients with 44 mechanical connectors were studied with 64-slice cardiac computed tomography. Eight patients had died previously, 6 patients refused to undergo a computed tomographic scan, and 4 patients had to be excluded because of impaired renal function.

Results

From a total of 44 mechanical connectors studied, 24 (55%) were occluded, 20 (45%; confidence intervals 31%–61%) were patent, and 7 of these grafts showed stenosis in the area of the connector. Mean follow-up was 41 ± 10 months (18-52 months). Sex, age, left main stenosis, hyperlipidemia, hypertension, renal failure, target vessel, stenosis of the target vessel, diameter of the target vessel, type of surgical intervention, diabetes, ejection fraction, postoperative anticoagulation regimen, and the connector size showed no significant influence on the bypass graft patency (P > .05). The bypass graft flow was recognized to be the only risk factor for bypass graft occlusion (P = .0256).

Conclusion

Midterm follow-up data show a high number of occluded Symmetry aortic connector system vein grafts. On the basis of these observations, the use of the connector was abandoned at our institution.

CTSNet classification: 23, 28

Abbreviations and Acronyms: AVR, aortic valve replacement, CABG, coronary artery bypass grafting, MSCT, multislice computed tomography, SACS, Symmetry aortic connector system