J Korean Med Sci 2006; 21: 849-53 ISSN 1011-8934 Copyright The Korean Academy of Medical Sciences Mid-Term Follow Up of Patients Using The St. Jude Medical Aortic Connector System for Proximal Vein Graft in CABG The aortic connector system may reduce stroke during proximal venous anasto- mosis. However, the overall anastomotic patency rate has been generally reported to be low. From October 2002 to March 2004, 68 patients who received proximal anastomosis using the St. Jude Aortic Connector System were included in the study. There were 47 men and 21 women and their mean age was 65.68±6.68 yr old (52 to 85 yr). Grafts were evaluated by coronary angiography or multi-slice 16 channel 3-D CT at 6 days and at 6 months postoperatively. In the immediate postoperative period, no stenosis was observed by either angiography (n=22) or 3D CT (n=46). At 6-month postoperatively, we performed either angiography (n=7) or 3-D CT (n= 52). Of these patients, 5 patients showed graft stenosis in the midportion, and 3 in the ostium. There were no stroke. Simple, and effective proximal anastomosis with good protection from cerebrovascular accident was achieved especially when calci- fication or atheromatous plaque was observed at the ascending aorta in the opera- tion room. However, our mid term patency results raise concerns related to venous graft stenosis in the midportion. Therefore, longer follow up is recommended. Key Words : Coronary Artery Bypass; Aortic Connector System; Graft Stenosis Cheol Hyun Chung, Jae Won Lee, Joon Kyu Kang, Hyun Song, Suk Jung Choo, Meong Gun Song Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea Received : 26 December 2005 Accepted : 29 March 2006 Address for correspondence Jae Won Lee, M.D. Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan, 388-1 Pungnap-2dong, Songpa-gu, Seoul 138-736, Korea Tel : +82.2-3010-3580, Fax : +82.2-3010-6966 E-mail : jwlee@amc.seoul.kr INTRODUCTION Off-pump coronary artery bypass grafting (CABG) and minimally invasive coronary artery bypass have been widely applied as safe alternatives to conventional CABG by avoid- ing the possible undesirable effects associated with cardiopul- monary bypass and touching the atheromatous aorta. Tradi- tionally a partial occluding clamp is placed on the ascending aorta and proximal anastomosis is achieved by hand-suturing the graft to a neo-ostium punched in the aortic wall during both on- and off-pump surgery. Hand suturing is an effec- tive, standard technique to anastomose vein graft, but the quality of the anastomosis is depends on skill level, experi- ence and the time permitted and furthermore manipulation of the aorta may exposes patients to possible embolization of the atheromatous debris from the aorta, as well as poten- tial aortic dissection. Set against this background and grow- ing interests in less invasive CABG techniques, semiauto- matic devices that can facilitate proximal anastomosis with- out clamping the aorta have been developed. The Aortic Connector System developed by St. Jude Med- ical Anastomotic Technology Group, Inc. (Minneapolis, MN, U.S.A.) has been used for years since approval of FDA of the United States was obtained in May 2001 for its use as alter- native tools for proximal anastomosis (1). Some have report- 849 ed early satisfactory results with this system comparable to those achieved using conventional method (2-5), however, others have reported early ostial saphenous vein graft steno- sis (6-8). In the present article, we review our initial experience and the mid-term results obtained using the Aortic Connector System (ACS; St. Jude Medical, Inc.) at the time of CABG and report some cases of venous graft stenosis in the mid por- tion which suggest the possibility of mechanical trauma to the endothelial lining which might be caused during saphe- nous vein loading onto the transfer sheath of the aortic con- nector. MATERIALS AND METHODS From October 2002 to March 2004, total 941 patients underwent CABG with or without cardiopulmonary bypass. Among these, 68 patients who received proximal anastomo- sis with the Symmetry Aortic connector were included in this study. We applied it whenever moderate to severe aortic calci- fication was observed in the preoperatively performed echocar- diography or atherosclerotic plaque was palpable in operation field that did not allow to do side clamp. There were 47 men and 21 women and their mean age was 65.68±6.68 yr (52