Surgical Coronary Revascularization Using an Off-Pump, No-Touch Technique: The Cyclone (Hexalon) Experience

Jeffrey M. Schussler^1,2, Theodore T. Theologes³, Baron L. Hamman^3*

¹Division of Cardiology, Baylor University Medical Center, Dallas, TX, USA.
²Texas A & M College of Medicine, Dallas, TX, USA.
³Division of Cardiothoracic Surgery, Baylor University Medical Center, Dallas, TX, USA.

DOI: 10.4236/ojts.2014.44019                

Abstract

The Cyclone^TM System (Castlewood Surgical, Inc., Concord, MA) is a novel device that facilitates the attachment of the saphenous vein onto the ascending aorta for the purpose of creating a bypass graft during a coronary artery bypass grafting (CABG) operation. It allows the surgeon to perform a hand-sewn anastomosis with no disruption of the intima of the aorta, and no need for partial clamping. During a 36-month period 109 CABG operations were performed, and the Cyclone^TM System (and its predecessor, the Hexalon^TM) was utilized to create 138 proximal anastomoses. This study demonstrates that this is a safe and effective method of creating a clampless, no-touch proximal anastomoses during off-pump CABG.

Keywords

No Touch, Clampless, Coronary Bypass, CABG, Anastomoses, Stroke

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Ayad, R.F., Bhella, P.S., Dockery, W.D., et al. (2011) Patency of Vein Graft Anastomoses Facilitated with the Hexalon Device. The Annals of Thoracic Surgery, 91, 894-898. http://dx.doi.org/10.1016/j.athoracsur.2010.11.029
[2]	Surgeons TSoT (2012) STS Risk Calculator.
[3]	Serruys, P.W., Morice, M.C., Kappetein, A.P., et al. (2009) Percutaneous Coronary Intervention versus Coronary-Artery Bypass Grafting for Severe Coronary Artery Disease. The New England Journal of Medicine, 360, 961-972. http://dx.doi.org/10.1056/NEJMoa0804626
[4]	Bucerius, J., Gummert, J.F., Borger, M.A., et al. (2003) Stroke after Cardiac Surgery: A Risk Factor Analysis of 16,184 Consecutive Adult Patients. The Annals of Thoracic Surgery, 75, 472-478. http://dx.doi.org/10.1016/S0003-4975(02)04370-9
[5]	El Zayat, H., Puskas, J.D., Hwang, S., et al. (2012) Avoiding the Clamp during Off-Pump Coronary Artery Bypass Reduces Cerebral Embolic Events: Results of a Prospective Randomized Trial. Interactive Cardiovascular and Thoracic Surgery, 14, 12-16. http://dx.doi.org/10.1093/icvts/ivr004
[6]	van der Linden, J., Hadjinikolaou, L., Bergman, P., et al. (2001) Postoperative Stroke in Cardiac Surgery Is Related to the Location and Extent of Atherosclerotic Disease in the Ascending Aorta. Journal of the American College of Cardiology, 38, 131-135. http://dx.doi.org/10.1016/S0735-1097(01)01328-6
[7]	Lamy, A., Devereaux, P.J., Prabhakaran, D., et al. (2012) Off-Pump or On-Pump Coronary-Artery Bypass Grafting at 30 Days. The New England Journal of Medicine, 366, 1489-1497. http://dx.doi.org/10.1056/NEJMoa1200388
[8]	Barbut, D., Hinton, R.B., Szatrowski, T.P., et al. (1994) Cerebral Emboli Detected during Bypass Surgery Are Associated with Clamp Removal. A Journal of Cerebral Circulation, 25, 2398-2402. http://dx.doi.org/10.1161/01.STR.25.12.2398
[9]	Calafiore, A.M., Di Mauro, M., Teodori, G., et al. (2002) Impact of Aortic Manipulation on Incidence of Cerebrovascular Accidents after Surgical Myocardial Revascularization. The Annals of Thoracic Surgery; 73, 1387-1393. http://dx.doi.org/10.1016/S0003-4975(02)03470-7
[10]	Barbut, D., Yao, F.S., Hager, D.N., et al. (1996) Comparison of Transcranial Doppler Ultrasonography and Transesophageal Echocardiography to Monitor Emboli during Coronary Artery Bypass Surgery. A Journal of Cerebral Circulation, 27, 87-90. http://dx.doi.org/10.1161/01.STR.27.1.87
[11]	Kouchoukos, N.T., Wareing, T.H., Daily, B.B., et al. (1994) Management of the Severely Atherosclerotic Aorta during Cardiac Operations. Journal of Cardiac Surgery, 9, 490-494. http://dx.doi.org/10.1111/j.1540-8191.1994.tb00881.x
[12]	Donsky, A.S., Schussler, J.M., Donsky, M.S., et al. (2002) Thrombotic Occlusion of the Aortic Ostia of Saphenous Venous Grafts Early after Coronary Artery Bypass Grafting by Using the Symmetry Aortic Connector System. The Journal of Thoracic and Cardiovascular Surgery, 124, 397-399. http://dx.doi.org/10.1067/mtc.2002.124236
[13]	Emmert, M.Y., Seifert, B., Wilhelm, M., et al. (2011) Aortic No-Touch Technique Makes the Difference in Off-Pump Coronary Artery Bypass Grafting. The Journal of Thoracic and Cardiovascular Surgery, 142, 1499-1506. http://dx.doi.org/10.1016/j.jtcvs.2011.04.031
[14]	Bolotin, G., Shapira, Y., Gotler, Y., et al. (2007) The Potential Advantage of “No-Touch” Aortic Technique in Off- Pump Complete Arterial Revascularization. International Journal of Cardiology, 114, 11-15. http://dx.doi.org/10.1016/j.ijcard.2005.11.107
[15]	Misfeld, M., Potger, K., Ross, D.E., et al. (2010) “Anaortic” Off-Pump Coronary Artery Bypass Grafting Significantly Reduces Neurological Complications Compared to Off-Pump and Conventional On-Pump Surgery with Aortic Manipulation. The Thoracic and Cardiovascular Surgeon, 58, 408-414. http://dx.doi.org/10.1055/s-0030-1249831