69 Clampless Arterial Coronary Artery Bypass Grafting with the Use of Magnetic Coupling Devices Thanos Athanasiou, M.D., Ph.D., F.E.T.C.S., Hutan Asrafian, M.B.B.S., George Krasopoulos, M.D., F.R.C.S., Sanjay Purkayastha, M.R.C.S., Vitali Malinowski, M.B.B.S., Sharif Al-Ruzzeh, F.R.C.S., Brian Glenville, F.R.C.S., Rex De La Stanbridge, F.R.C.S., and Roberto Casula, M.D., F.E.T.C.S. The National Heart and Lung Institute, Imperial College of Science, Technology and Medicine, Department of Cardiothoracic Surgery, St. Mary’s Hospital, London, United Kingdom ABSTRACT Background: The aim of our study was to evaluate the feasibility of using the Ventrica MVP ® device to perform proximal anastomoses as part of the clampless off-pump coronary artery bypass (OPCAB) arterial revascularization procedure. Methods: We present our preliminary experience of these first nine coronary artery cases performed in the UK from April 2003 to December 2004. Results: The device was used in eight patients for the proximal anastomosis of a radial artery (n = 8) or right internal thoracic artery (n = 1) graft as a Y-graft from the left internal thoracic artery to the circumflex territories. One patient died in this series although the autopsy showed that the device was intact and free of clots and the reported cause of death was an acute cardiac event due to myocardial ischemia. Anastomotic patency was confirmed in five patients with the use of multidetector row computed tomography coronary angiogram. The anastomosis time in our series was 6.3 ± 2.1 minutes and the blood loss 814 ± 245 mL. The mean length of stay was 5.2 ± 1.2 days. No other significant major morbidity events were observed postoperatively (neurological complications, renal failure, and reopening for bleeding). The assessment of quality of life at 6 months postoperatively using SF-36 questionnaires revealed improvement. Conclusion: The versatile use of Ventrica MVP ® distal anastomotic device is feasible in clinical practice allowing surgeons to perform proximal anastomoses and arterial OPCAB surgery with short learning curve and without compromising the clinical outcome and quality of life. doi: 10.1111/j.1540-8191.2006.00172.x (J Card Surg 2006;21:69-74) Surgical strategies including off-pump coronary artery bypass (OPCAB) combined with complete avoid- ance of aortic manipulation and total arterial revascu- larization may further reduce perioperative stroke and morbidity in addition to the benefits achieved by avoid- ing cardiopulmonary bypass (CPB) and cardioplegic ar- rest. 1 High-risk patients being considered for surgical revascularization such as the elderly and those with sig- nificant left main stem disease are rapidly growing and can be considered as challenging groups of patients due to the fact that the prevalence of comorbid fac- tors, such as previous cerebrovascular disease, carotid disease, and aortic atherosclerosis is high. 2,3 The aim of our study is to evaluate the feasibility of using the Ventrica MVP ® device (MVP ® -Ventrica, Inc., Fremont, CA, USA), to perform proximal anastomoses as part of the clampless OPCAB arterial revascularization proce- dure. A similar series has not published in the literature before. The selection criteria, surgical technique, post- operative clinical outcome, follow-up factors such as patency outcome, and quality of life (SF-36) at 6 months Address for correspondences: Thanos Athanasiou, M.D., Ph.D., F.E.T.C.S., 70 St. Olaf’s Road, Fulham, London SW6 7DN, UK. Fax: +44 0207 886 6777; e-mail: tathan5253@aol.com postoperatively, advantages or disadvantages, and fu- ture implications are all discussed. METHODS We present our preliminary experience of these first nine coronary artery cases performed in the UK. The records of these consecutive patients who underwent the procedure at St. Mary’s Hospital between April 2003 and December 2004 were reviewed retrospec- tively. Health-related quality of life (HRQOL) assess- ment was planned in a prospective design. Patients were contacted by telephone to conduct a semistruc- tured interview and completed the short form health survey (SF-36) questionnaire. This validated question- naire has been widely used in medical practice and re- search, and used with cardiac surgery patients. It con- sists of 36 items measuring eight different aspects of HRQOL: physical functioning, social functioning, role limitations due to physical problems, role limita- tions due to emotional problems, mental health, energy and vitality, body pain, and general health. Database registry, medical notes, and charts were studied for preoperative and postoperative data of the patients. Follow-up was performed at least 6 months after the