The Telegraph
Since 1st March, 1999
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Now, get a bypass done minus cutting & sewing

Hyderabad, Nov. 3 (PTI): India has joined a select group of nations that have the expertise to conduct sutureless bypass surgery using a new device that can automatically punch a hole in the aorta and insert one end of a graft.

The device — called symmetry bypass system aortic connector — was used here on a 56-year-old person from Madhya Pradesh, paving the way for semi-automated bypass surgery. Surgeons in the US and some European nations had been using the device for about six months but it was tried out for the first time in India a few days ago, cardiothoracic surgeon Dr Vijay Dikshit said today.

The three basic components of the system include an aortic cutter, a delivery system, and an aortic connector. The cutter is used to make a uniform hole in the aorta for attaching the vein bypass graft.

The delivery system, which resembles a long-handled screwdriver, is pre-loaded with a vein graft and the star-shaped aortic connector. The tip of the delivery system is placed in the hole created by the aortic cutter and, by pressing a button on the handle of the system, the connector is released and expands to form its star shape.

In just few seconds, a surgeon can attach and seal a vein graft to the aorta mechanically, against the 10 minutes it would have taken to sew the vessel to the aorta, as was done in the past. The seal does not allow blood to flow out from where the vessels are joined.

When the delivery system is removed, the last portions of the connector come into place. The new connection is as secure as traditional sutures.

In the normal coronary artery bypass surgery, doctors drill a hole in the main artery supplying oxygenated blood (aorta) and then sew the graft material, usually a vein harvested from the leg. The other end of the graft material is then connected to an area beyond the block, thus bypassing a clog in the artery that supplies blood to heart muscles.

The sewing procedure takes a long time and often disturbs the aorta, leading to the release of small plaques (fatty materials), Dikshit said. These plaques can migrate to the brain and create post-operative complications such as stroke, transcient loss of memory or neurocognitive dysfunction (deficiency in the patient’s reasoning ability).

Surgeons also clamp the aorta during bypass surgery to sew the graft material. This, Dikshit said, can cause injury to the aorta. As blood exits the left ventricle and enters the aorta under great pressure, this can cause small tears within the layers of the aorta and cause the vessel to split.

This is an infrequent but serious complication of bypass surgery. The ability to perform clampless (sutureless) aortic suturing has the potential of reducing the risks associated with cardiac bypass surgery, he said.

“Reducing the risk of coronary bypass surgery will result in a better quality of life for the patient after surgery,” said Dikshit, chief cardiothoracic surgeon at Apollo Hospitals.

The symmetry bypass system aortic connector eliminates the need for clamps and can be performed on a beating heart as well, he said. This new technology has the potential to revolutionise the way bypass surgery is performed, he said.

The device was developed by St Jude Medical Inc., US, Dikshit said, adding that the symmetry bypass system also reduces procedure time.

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