{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,2]],"date-time":"2025-10-02T18:41:26Z","timestamp":1759430486388,"version":"build-2065373602"},"reference-count":24,"publisher":"IMR Press","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["HSF"],"abstract":"<jats:p>&lt;p&gt;&lt;b&gt;Objectives:&lt;\/b&gt; The benefit of off-pump coronary artery bypass (OPCAB) surgery may be reduced by strokes caused by microemboli produced after aortic side-clamping for proximal bypass anastomoses. The Heartstring device allows constructing proximal bypass anastomoses without side-clamping of the aorta.&lt;\/p&gt;&lt;p&gt;&lt;b&gt;Methods:&lt;\/b&gt; This retrospective study describes 260 consecutive patients who underwent OPCAB surgery; 442 proximal anastomoses were performed with the Heartstring device in this series. Ten percent of the patients were randomly sampled before discharge to undergo a coronary angiogram for assessment of graft patency.&lt;\/p&gt;&lt;p&gt;&lt;b&gt;Results:&lt;\/b&gt; Intraoperative Doppler measurements confirmed regular bypass function. Early mortality occurred in 4 patients (1.5%), and stroke occurred in 2 patients (0.8%). Device-related bleeding was negligible, and there were no cases of aortic dissection. Perioperative ischemia occurred in 8 patients (3.1%). Predischarge coronary angiography evaluations in 25 of the patients (of 260) showed that all 42 Heartstring-assisted anastomoses (of 442) were patent. Conclusions: Clampless performance of proximal bypass anastomoses combined with OPCAB is associated with a very low incidence of stroke complications. Short-term follow-up has shown excellent results regarding bypass patency and other adverse events. Prospective randomized trials are required to confirm the advantage of this technique.&lt;\/p&gt;<\/jats:p>","DOI":"10.1532\/hsf98.20111036","type":"journal-article","created":{"date-parts":[[2011,12,13]],"date-time":"2011-12-13T21:15:35Z","timestamp":1323810935000},"page":"360","source":"Crossref","is-referenced-by-count":4,"title":["Avoidance of Aortic Side-Clamping for Proximal Bypass Anastomoses: Better Short-term Outcome?"],"prefix":"10.31083","volume":"14","author":[{"given":"Markus J.","family":"Wilhelm","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Syburra","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lukas","family":"Furrer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J\ufffdrgen","family":"Frielingsdorf","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dragan","family":"Odavic","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kirk","family":"Graves","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michele","family":"Genoni","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"16242","published-online":{"date-parts":[[2011,12,13]]},"reference":[{"key":"1","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1111\/j.1540-8191.2006.00172.x","article-title":"Clampless arterial coronary artery bypass grafting with the use of magnetic coupling devices","volume":"21","author":"T. Athanasiou","year":"2006","journal-title":"J Card Surg"},{"key":"2","doi-asserted-by":"crossref","first-page":"2398","DOI":"10.1161\/01.STR.25.12.2398","article-title":"Cerebral emboli detected during bypass surgery are associated with clamp removal","volume":"25","author":"D. Barbut","year":"1994","journal-title":"Stroke"},{"key":"3","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1016\/j.jamcollsurg.2004.03.014","article-title":"Off-pump versus on-pump coronary artery bypass surgery: does the pump influence outcome?","volume":"199","author":"A. Berson","year":"2004","journal-title":"J Am Coll Surg"},{"key":"4","doi-asserted-by":"crossref","first-page":"1434","DOI":"10.1016\/S0003-4975(02)04839-7","article-title":"Pitfalls and key lessons with the Symmetry proximal anastomotic device in coronary artery bypass surgery","volume":"75","author":"T. 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Di Giammarco","year":"2006","journal-title":"J Thorac Cardiovasc Surg"},{"key":"7","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1016\/j.jtcvs.2006.10.002","article-title":"Gaseous and solid cerebral microembolization during proximal aortic anastomoses in off-pump coronary surgery: the effect of an aortic side-biting clamp and two clampless devices","volume":"133","author":"L. Guerrieri Wolf","year":"2007","journal-title":"J Thorac Cardiovasc Surg"},{"key":"8","doi-asserted-by":"crossref","first-page":"638","DOI":"10.1253\/circj.70.638","article-title":"The HEARTSTRING proximal seal system is a possible source of atheroembolism","volume":"70","author":"S. Kanemitsu","year":"2006","journal-title":"Circ J"},{"key":"9","doi-asserted-by":"crossref","first-page":"1564","DOI":"10.1016\/j.athoracsur.2004.05.019","article-title":"The impact of aortic manipulation on neurologic outcomes after coronary artery bypass surgery: a risk-adjusted study","volume":"78","author":"E. Kapetanakis","year":"2004","journal-title":"Ann Thorac Surg"},{"key":"10","doi-asserted-by":"crossref","first-page":"1028","DOI":"10.1016\/j.jtcvs.2005.05.026","article-title":"Early and midterm patency of the proximal anastomoses of saphenous vein grafts made with a Symmetry Aortic Connector System","volume":"130","author":"H. Kitamura","year":"2005","journal-title":"J Thorac Cardiovasc Surg"},{"key":"11","doi-asserted-by":"crossref","first-page":"1448","DOI":"10.1001\/jama.287.11.1448","article-title":"Protecting the brain in coronary artery bypass graft surgery","volume":"287","author":"D. Mark","year":"2002","journal-title":"JAMA"},{"key":"12","doi-asserted-by":"crossref","first-page":"993","DOI":"10.1016\/j.ejcts.2004.02.036","article-title":"Automatic connector devices for proximal anastomoses do not decrease embolic debris compared with conventional anastomoses in CABG","volume":"25","author":"S. 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Newman","year":"2001","journal-title":"Stroke"},{"key":"16","doi-asserted-by":"crossref","first-page":"1192","DOI":"10.1016\/S0022-5223(03)00800-6","article-title":"Combination of the HEARTSTRING proximal seal system with a blower mister: a possible source of gas emboli","volume":"126","author":"G. Nollert","year":"2003","journal-title":"J Thorac Cardiovasc Surg"},{"key":"17","doi-asserted-by":"crossref","first-page":"1393","DOI":"10.1161\/01.STR.25.7.1393","article-title":"The impact of microemboli during cardiopulmonary bypass on neuropsychological functioning","volume":"25","author":"W. Pugsley","journal-title":"Stroke"},{"key":"18","doi-asserted-by":"crossref","first-page":"1421","DOI":"10.1016\/j.jtcvs.2004.01.015","article-title":"Early bypass occlusion after deployment of nitinol connector devices","volume":"127","author":"O. 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