Anastomotic Devices for Coronary Artery Surgery

Abstract

The cornerstone of coronary artery bypass surgery undoubtedly remains a perfectly constructed anastomosis, whether it be for graft inflow, such as that between the aorta and a bypass conduit, or for distal perfusion, namely a graft touching down on a target vessel. Multiple studies have demonstrated the long-term efficacy of coronary surgery in alleviating angina syndromes, in enhancing left ventricular function, and, consequently, in improving survival in select patients. Nevertheless, coronary surgeons need to continually strive to do better; the perfect anastomosis is, in and of itself, now no longer enough. With drug-eluting coronary stents and transcatheter therapies rapidly continuing to improve, those patients who require surgery demand more minimally-invasive procedures, through ever-smaller incisions, with more durable grafts, associated with superior long-term patency, and they will not accept the small, but finite risk of stroke that has traditionally been associated with coronary grafting. Anastomotic devices are uniquely suited to fill this niche. They afford the coronary surgeon the opportunity to evolve their technique without compromising on quality. They can eliminate inter and intra-surgeon variability in technical proficiency ensuring rapid construction of reliable, reproducible, and compliant anastomoses, often in difficult-to-access areas, while concomitantly reducing the risk of perioperative neurological injury. The majority of anastomotic devices that have been introduced into the market over the past two decades or so are no longer in use. However, there are still a few that are readily available, with substantial clinical evidence supporting their efficacy.