J Artif Organs (2005) 8:95–99 © The Japanese Society for Artificial Organs 2005 DOI 10.1007/s10047-005-0293-0 ORIGINAL ARTICLE Masashi Toyama, MD · Akihiko Usui, MD Tomonobu Abe, MD · Masaharu Yoshikawa, MD Toshiaki Akita, MD · Yuichi Ueda, MD Early clinical results of St. Jude Medical Symmetry aortic connector Abstract An automated anastomosis device named St. Jude Medical symmetry aortic connector has been used worldwide for off-pump coronary artery bypass grafting. However, early graft obstruction was recently reported, and its predictors should be clarified. From April 2002 to March 2004, 38 patients in our institution underwent off-pump coronary artery bypass grafting using the St. Jude Medical Symmetry aortic connector for saphenous vein graft (SVG) procedures; measurement of intraoperative graft flow and postoperative coronary angiography was performed. Early SVG events occurred in 9 (24%) patients: 8 occlusion cases and 1 case of stenosis. Predictors of early SVG events were assessed from a comparative study. Univariate logistic re- gression identified hyperlipidemia as the only significant predictor of early SVG events (P = 0.02, odds ratio 7.78). Lower SVG flow rate and poor ejection fraction did not show statistical significance (P = 0.09, odds ratio 1.09 and P = 0.09, odds ratio 0.96). The SVG event rate was much higher for the left circumflex branch compared with other locations (31% vs. 9%, P = 0.03) and decreased with in- creasing aortic connector size (small, 32%; median, 14%; large, 0%). Multivariate analysis did not identify a predictor of SVG events. The aortic connector is associated with a high incidence of early SVG events. Patients should be cautiously selected and the procedure should not be used for left anterior descending coronary artery or culprit lesions. Key words Saphenous vein graft · Patency · Aortic connec- tor · Hyperlipidemia · Graft flow Received: November 18, 2004 / Accepted: April 15, 2005 M. Toyama (*) · A. Usui · T. Abe · M. Yoshikawa · T. Akita · Y. Ueda Department of Cardiothoracic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan Tel. +81-52-744-2376; Fax +81-52-744-2383 e-mail: machapon@med.nagoya-u.ac.jp Introduction An automated proximal anastomosis device for saphenous vein graft (SVG) procedures has been used worldwide in off-pump coronary artery bypass grafting (OPCAB). The device allows anastomosis of a SVG to the ascending aorta with minimal manipulation of the aorta. However, there have been several reports of early occlusion of the SVG. Reported causes of occlusion to date have included intimal proliferation induced by a foreign-body reaction, abnormal flow dynamics, kinking of the SVG, or debris. 1–7 However, a predictor for early SVG occlusion has not been identified. We evaluated several factors including preoperative, intra- operative, and postoperative parameters and assessed these as predictors for early SVG occlusion. Material and methods In our institution, in situ or composite arterial bypass with the left internal thoracic artery (LITA) being anastomosed to the left anterior descending coronary artery (LAD) was a principal strategy in OPCAB. However, SVG procedures have been used according to the patient’s condition since the St. Jude Medical (SJM) Symmetry aortic connector be- came commercially available as an automated anastomosis device in April 2002. We used aortic connectors for proximal anastomosis of the SVG in 49 patients up to March, 2004. Forty-two patients underwent postoperative coronary angiography within 2 months of surgery to investigate early SVG pa- tency. SVG flow was measured intraoperatively with a tran- sonic doppler flow meter (Model HT107; Transonic, Ithaca, NY, USA) in 38 (90.5%) of the 42 patients. These 38 patients were enrolled in this study. Early post- operative angiography revealed SVG occlusion in 8 cases and 90% stenosis of the proximal anastomosis in 1 case (Fig. 1). Nine (24%) of these 38 patients had had SVG events. We performed a comparative clinical study between