Asian Cardiovasc Thorac Ann 2007;15:444-445
© 2007 Asia Publishing EXchange Ltd
Easy Technique for Mounting the Heartstring System into the Sheath
Hirofumi Takemura, MD,
Yukiomi Fukumoto, MD,
Tadamasa Miyauchi, MD,
Katsuya Shimabukuro, MD,
Matsuhisa Imaizumi, MD,
Narihiro Ishida, MD
Department of General and Cardiothoracic Surgery, Graduate School of Medicine, Gifu University, Gifu, Japan
For reprint information contact: Hirofumi Takemura, MD, Tel: 81 58 230 6720, Fax: 81 58 230 6326, Email: takemura{at}cc.gifu-u.ac.jp, Department of General and Cardiothoracic Surgery, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan.
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ABSTRACT
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The Heartstring system was developed to avoid the use of side-biting aortic clamps, but the sealing system sometimes tears. To solve this problem, a string is wound around the coiled seal and pulled gently.
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INTRODUCTION
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The Heartstring (Guidant, Indianapolis, IN, USA) was designed to enable the creation of a clampless hand-sewn proximal anastomosis for coronary artery bypass grafting. The sealing system must be mounted into the sheath just before use as the shape of the sealing system must be maintained for a clampless hemostatic seal. As noted by Vicol and colleagues,1 loading the sealing system into the sheath sometimes tears the seal (Figure 1
). To avoid this problem, they recommended warming the sealing system before use. We have developed an easy and quick technique to mount the system, which does not require warming.
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TECHNIQUE
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A string is wound around the system at the center of the device (Figure 2A). The string is pulled gently and slowly, then one edge of the system is pushed under the opposite edge (Figure 2B). The system does not tear using this approach (Figure 2C). The Heartstring is then inserted into the anastomotic hole. A single push of the plunger deploys the system. Finally, the anastomosis is performed by a standard technique with hand-sewing methods using 6/0 polypropylene suture with a BV-1 needle, which is better suited to this anastomosis than a C-1 needle in terms of a lower risk of piercing the Heartstring.
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Figure 2. How to load the sealing system into the sheath: (A) a string is wound around the sealing system; (B) the string is pulled gently; (C) after the seal has been rolled up, it is inserted into the sheath.
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DISCUSSION
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Total arterial revascularization has been reported to be beneficial in terms of long-term graft patency and survival.2 However, some patients with a small arterial conduit and those on hemodialysis require vein grafts. Partial aortic clamping is necessary when a vein graft is connected to the ascending aorta, given the risk of cerebral embolization. An automatic aortic connector, the Symmetry system (St. Jude Medical, St. Paul, MN, USA) was designed to avoid partial aortic clamping, but it has shown lower patency rates for vein grafts compared to hand-sewn anastomoses.3,4 Another concern with this device is the angle of the vein graft against the ascending aorta. An angled take-off from the proximal anastomosis might kink the vein graft, particularly for circumflex grafting. The Heartstring system was developed to avoid both partial aortic clamping for anastomosis of vein grafts to the aorta and also the presence of metal material in the graft. The quality of the anastomosis and duration of patency using this system should be almost identical to those of hand-sewn anastomoses using partial aortic clamping.5 We have used 24 Heartstring systems in 16 patients. All anastomoses were performed without complications such as bleeding from the anastomosis site, neurological defects, or graft occlusions. However, Nollert and colleagues6 have warned of the possibility of gas embolization.
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REFERENCES
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- Vicol C, Oberhoffer M, Nollert G, Eifert S, Boekstegers P, Wintersperger B, et al. First clinical experience with the HEARTSTRING, a device for proximal anastomoses in coronary surgery. Ann Thorac Surg 2005;79:1732–7.[Abstract/Free Full Text]
- Muneretto C, Bisleri G, Negri A, Manfredi J, Metra M, Nodari S, et al. Total arterial myocardial revascularization with composite grafts improves results of coronary surgery in elderly: a prospective randomized comparison with conventional coronary artery bypass surgery. Circulation 2003;108 Suppl 1:II29–33.[Medline]
- Hornik L, Tenderich G, Minami K, Fassbender D, Schulz TO, Beinert B, et al. First experience with the St. Jude Medical, Inc, Symmetry Bypass System (Aortic Connector System). J Thorac Cardiovasc Surg 2003;125:414–7.[Free Full Text]
- Carrel TP, Eckstein FS, Englberger L, Windecker S, Meier B. Pitfalls and key lessons with the Symmetry proximal anastomotic device in coronary artery bypass surgery. Ann Thorac Surg 2003;75:1434–6.[Abstract/Free Full Text]
- HEARTSTRING II proximal seal system. Available at: http://www.guidant.com/products/ProductTemplates/CS/heartstring.shtml
- Nollert G, Oberhoffer M, Reichart B, Vicol C. Combination of the HEARTSTRING proximal seal system with a blower mister: a possible source of gas emboli. J Thorac Cardiovasc Surg 2003;126:1192–4.[Free Full Text]
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ABSTRACT
INTRODUCTION
