Sutureless versus Hand-Sewn Coronary Anastomoses: A Systematic Review and Meta-Analysis

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: anastomosis; coronary artery bypass grafting; minimally invasive; sutureless coronary anastomotic device.

Figure 1

PRISMA flow-chart of systematic review search outcomes. CABG: coronary artery bypass grafting; CAG, coronary angiography; MREC: medical research ethics committee; CTa: computed tomography angiography; cMR: cardiac magnetic resonance imaging.

Figure 2

Overview of the sutureless coronary anastomotic devices included in the systematic review.

Figure 3

Forest plot on anastomotic patency, presented per device subgroup. Line of no effect represented by vertical line. Outcome measures for individual studies are presented per box (risk ratio) and horizontal line (95% confidence interval). The summary outcome per device group and for the total group is presented in a diamond shape (risk ratio and 95% confidence interval).