Mid-term patency after magnetic coupling for distal bypass anastomosis in coronary surgery

Background. The magnetic vascular positioner (MVP), a device for distal bypass anastomosis in coronary surgery, was developed to allow a simple and rapid procedure and to improve graft patency. We analyze our mid-term results with this device. Methods. Eighteen distal anastomoses were performed by using the MVP, and 18 with a hand-sewn technique were completed in 11 patients. The target arteries for the MVP anastomosis were the left anterior descending in 9 patients, a marginal branch in 4, a diagonal branch in 3, and right coronary artery in 2. The left internal thoracic artery was used as graft in 9 patients, saphenous vein in 6, right internal thoracic artery in 2, and radial artery in 1. Results. Coronary angiography was performed at discharge and after a complete follow-up of 19 +/- 3.5 months. Patency at follow-up was 83.3% (15/18) for MVP anastomoses and 100% (18/18) for hand-sewn anastomoses. All occluded MVP anastomoses were performed with small-size devices. In one patient, a high-grade left main stenosis was overestimated. Competitive flow may be suspected in this case as a cause of graft occlusion. No deaths occurred during hospital stay or during follow-up. Freedom from reintervention was 100%. Conclusions. The MVP is the only mechanical connector for distal anastomoses applicable for all kind of grafts, for all coronary artery locations, and with both end-to-side and side-to-side technique. Mid-term patency of MVP anastomoses is acceptable but inferior to the patency of hand-sewn anastomoses. Occlusion of MVP supplied grafts may be produced by small device size.