Hoogewerf Marieke, Schuurkamp Jeroen, Kelder Johannes C, Jacobs Stephan, Doevendans Pieter A
Department of Cardiology, University Medical Centre Utrecht, 3584 CX Utrecht, The Netherlands.
Department of Cardiothoracic Surgery, St. Antonius Hospital, 3435 CM Nieuwegein, The Netherlands.
J Clin Med. 2022 Jan 29;11(3):749. doi: 10.3390/jcm11030749.
Sutureless coronary anastomotic devices are intended to facilitate minimally invasive coronary artery bypass grafting (MICS-CABG) by easing and eventually standardizing the anastomotic technique. Within this systematic review and meta-analysis, we aim to determine patency and to evaluate safety outcomes for the sutureless anastomoses.
CENTRAL, MEDLINE, and EMBASE were searched from database start till August 2021 in a predefined search strategy combining the key concepts: 'coronary artery bypass grafting', 'sutureless coronary anastomoses', and 'hand-sewn coronary anastomoses' by the Boolean operation 'AND'. Study characteristics, patient demographics, interventional details, and all available outcome data were extracted. A meta-analysis was performed on patency at longest follow-up. Safety outcomes were presented.
A total of eleven trials towards six sutureless anastomotic devices were included, comprising 3724 patients (490 sutureless and 3234 hand-sewn). There was no significant difference in patency at a mean follow-up duration of 546.3 (range 1.5-2691) days, with a risk ratio of 0.77 (95% CI 0.55-1.06). MACE was reported in 4.5% sutureless and 3.9% hand-sewn patients, including all-cause mortality (resp. 1.3 vs. 1.9%), myocardial infarction (resp. 1.6 vs. 1.7%), and coronary revascularization (resp. 1.8 vs. 0.5%). Incomplete hemostasis occurred in 24.8% of the sutureless anastomoses. Intra-operative device failure forced conversion to hand-sewn or redo-anastomosis in 5.8% of the sutureless cases.
Based on the systematic review and meta-analysis including six devices, we conclude that sutureless coronary anastomotic devices appear safe and effective when used by well-trained and dedicated surgical teams.
无缝线冠状动脉吻合装置旨在通过简化并最终标准化吻合技术，促进微创冠状动脉旁路移植术（MICS-CABG）。在本系统评价和荟萃分析中，我们旨在确定无缝线吻合的通畅率，并评估其安全性结果。
按照预先定义的检索策略，使用布尔运算符“AND”组合“冠状动脉旁路移植术”、“无缝线冠状动脉吻合”和“手工缝合冠状动脉吻合”等关键概念，检索CENTRAL、MEDLINE和EMBASE数据库，检索时间从建库至2021年8月。提取研究特征、患者人口统计学资料、干预细节和所有可用的结局数据。对最长随访期的通畅率进行荟萃分析，并呈现安全性结果。
共纳入针对6种无缝线吻合装置的11项试验，包括3724例患者（490例采用无缝线吻合，3234例采用手工缝合）。平均随访546.3天（范围1.5 - 2691天）时，通畅率无显著差异，风险比为0.77（95%CI 0.55 - 1.06）。采用无缝线吻合的患者中有4.5%报告发生主要不良心血管事件（MACE），采用手工缝合的患者中有3.9%，包括全因死亡率（分别为1.3%对1.9%）、心肌梗死（分别为1.6%对1.7%）和冠状动脉血运重建（分别为1.8%对0.5%）。24.8%的无缝线吻合发生止血不完全。5.8%的无缝线病例术中因装置故障被迫转为手工缝合或重新吻合。
基于包括6种装置的系统评价和荟萃分析，我们得出结论，当由训练有素且专注的手术团队使用时，无缝线冠状动脉吻合装置似乎是安全有效的。
