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Durchführung einer nahtlosen Anastomose für aortale Venengraftanschlüsse führt nicht zu einer Verbesserung des neuropsychologischen Outcomes

The use of a sutureless anastomotic system for aortic vein graft anastomoses does not lead to an improvement in neuropsychological outcome

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Zeitschrift für Herz-, Thorax- und Gefäßchirurgie Aims and scope

Zusammenfassung

Einleitung:

Die Insertion eines nahtlosen Aortenanastomosensystems während einer Koronararterien-Bypassoperation zur Erstellung proximaler Venengraftanastomosen reduziert Manipulationen an der Aorta ascendens. Daher könnte ein solches Anastomosensystem möglicherweise das neuropsychologische Outcome von Patienten nach Bypassoperationen verbessern.

Material und Methoden:

45 Patienten wurden in eine prospektiv-randomisierte Studie eingeschlossen, bei der ein kommerziell verfügbares nahtloses Anastomosensystem („Symmetry-Bypass-System Aortic Connector“, St. Jude Medical, Eschborn, Deutschland) mit konventioneller Bypasschirurgie verglichen wurde. Eine neuropsychologische Testbatterie wurde vor und 5 bis 8 Tage nach dem Eingriff angewendet, cerebrale Mikroembolien wurden mit Hilfe eines transkraniellen Dopplers (TCD) aufgezeichnet, so dass „High-intensitiy Transient Signals“ (HITS) intraoperativ gemessen werden konnten.

Ergebnisse:

Die Dauer des Eingriffs und der extrakorporalen Zirkulation (ECC) sowie die Anzahl distaler und proximaler Anastomosen waren nicht signifikant unterschiedlich zwischen beiden Gruppen. Auch die mittlere Anzahl der HITS während der ECC (konventionelle Gruppe 277±335, Connector-Gruppe 249±508 HITS) unterschied sich nicht signifikant. Interessanterweise wurden während der Insertion des nahtlosen Anastomosengerätes 16±15 HITS dokumentiert, während die mittlere Anzahl der HITS während der partiellen und totalen Aortenklemmung und des Öffnens der Aortenklemme 25±39 in der konventionellen Gruppe waren. In der Connectorgruppe mussten 6 von 23 Patienten aufgrund von connectorbezogenen Problemen von der Studie ausgeschlossen werden. In beiden Gruppen traten weder ein Schlaganfall noch ein Durchgangssyndrom postoperativ auf. Unterschiedliche statische Analysenmethoden der neuropsychologischen Tests zeigten ein leicht verschlechtertes neuropsychologisches Outcome in der Connectorgruppe, verglichen mit der konventionellen Gruppe.

Schlussfolgerung:

Der Einsatz eines „Symmetry Bypass System Aortic Connectors“ führt nicht zu einem besseren neuropsychologischen Ergebnis als eine Standard-Bypassoperation.

Summary

Objective:

The insertion of a sutureless aortic anastomosis (SAA) during coronary artery bypass surgery (CABG) for construction of proximal vein graft anastomoses may reduce manipulations of the aorta. Thus, SAA could possibly improve the neuropsychologic outcome of patients after CABG surgery.

Material and methods:

45 patients were included in a prospective, randomised study comparing a commercially available SAA (“Symmetry Bypass System Aortic Connector, St. Jude Medical, Inc., Minneapolis, USA) to conventional CABG surgery. A neuropsychological test battery was applied before and 5–8 days after surgery, cerebral microemboli were recorded using a transcranial Doppler (TCD) measuring high intensity transient signals (HITS) intraoperatively.

Results:

Duration of surgery, ECC (extracorporeal circulation) time and the number of distal and proximal anastomoses were not significantly different. The mean number of HITS during ECC (conv. CABG 277±335, SAA 249±508 HITS) did not differ significantly between the two groups. Interestingly, during insertion of the SAA device, a mean number of 16±15 HITS was documented, while the mean number of HITS during partial and complete clamping and declamping of the aorta was 25±39 in the conventional group. In the SAA group, 6/23 patients had to be excluded from the study due to SAA device-related problems. In both groups, no clinical apparent stroke or delirium occurred after surgery. Different statistical analyses of the neuropsychological tests (% group mean changes, 20% difference, linear regression) showed a slightly impaired neuropsychological outcome in the Connector group compared to the CABG group.

Conclusion:

The use of a “Symmetry Bypass System Aortic Connector” does not yield a better neurological outcome compared to a standard CABG procedure.

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Authors and Affiliations

  1. Klinik für Herz- und Gefäßchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 7, 24105, Kiel, Germany

    A. Böning, C. Dircksen, C. Friedrich & J. Cremer

  2. Klinik für Anästhesie, Schmerztherapie und Operative Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Germany

    B. Bein & S. Carstensen

  3. Institut für Biometrie und Medizinische Statistik, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Germany

    J. Hedderich

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  1. A. Böning
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  7. J. Cremer
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Correspondence to A. Böning.

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Böning, A., Bein, B., Dircksen, C. et al. Durchführung einer nahtlosen Anastomose für aortale Venengraftanschlüsse führt nicht zu einer Verbesserung des neuropsychologischen Outcomes. Z Herz-, Thorax-, Gefäßchir 18, 281–289 (2004). https://doi.org/10.1007/s00398-004-0470-0

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  • DOI: https://doi.org/10.1007/s00398-004-0470-0

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