STS: Long-Term Follow-Up Shows More Reintervention Needed With Mechanical Connectors

Patients undergoing coronary artery bypass graft (CABG) surgery who receive mechanical connectors require more target vessel reintervention at 2 years than sutured patients, according to results presented here on January 27th at the Society of Thoracic Surgeons 40th Annual Meeting.

In addition, patients receiving mechanical connectors have a lower rate of major adverse cardiac event (MACE)-free survival, the researchers said.

Dr. Todd Dewey and colleagues, Cardiopulmonary Research Science and Technology Institute, Dallas, Texas, United States, compared results in a group of patients who received isolated beating heart CABG using Symmetry™ anastomotic connectors and a group of control patients who received off-pump CABG with at least one hand-sutured vein graft in the preceding year.

Subjects were followed for cardiac mortality, myocardial infarction or the need for target vessel revascularisation using telephone survey, direct physician contact and the Social Security death index.

The analysis included 165 patients with mechanical connectors who were followed for a mean of 680 days and 152 control patients who were followed for a mean of 901 days.

“What we found was an accelerated accumulation of MACE events in the connector group occurring sometime between 180 and 360 days and also sometime between 720 and 900 days,” Dr. Dewey observed. “Notably, 31 adverse events occurred in the connector population during a mean follow up of 680 days, while only 24 adverse events were identified in control patients during a much longer follow-up of just over 900 days.”

There were 13 deaths (7.9%) among the connector group and 19 deaths (12.5%) among control patients; however, the difference was not statistically significant.

Repeat target vessel revascularisation was required in 9.7% of connector and 2.0% of hand-sutured patients (P < .004). The need for target vessel revascularisation tended to occur more frequently in patients with diabetes, especially those on oral medications. The incidence of myocardial infarction did not differ between the two groups. Connector patients who surpassed the early period of MACE aggregation did not subsequently demonstrate equivalent long-term performance compared to the hand-sutured control patients. Based on the findings, Dr. Dewey recommended that the current generation of mechanical connectors be avoided in diabetic patients undergoing CABG. He also called for continued aggressive follow-up of patients with implanted connectors and aggressive evaluation for return of symptoms.