**2.5 Clinical significance of Enclose technology**

Cerebrovascular complications are one of the most common complications after CABG. The main reasons could be mainly attributable to the atherosclerotic plaque or new thrombus falling off and embolism of ascending aorta or carotid artery during and after operation [14]. Other possible causes might be the excessive anticoagulation, or the sudden rise of blood pressure, causing the rupture and hemorrhage of cerebral vessels [15]. Atherosclerosis is a group of systemic diseases, and vascular endothelial dysfunction has been widely considered as the most important initiating link in its process and exists in the whole process of atherosclerosis. Atherosclerosis is a chronic, progressive and multiple endovascular disease, involving many large and medium-sized arteries. For patients with severe coronary atherosclerosis, especially those over 70 years old, the incidence of aortic atherosclerosis or calcification

**263**

**Figure 3.**

*The Heartstring device.*

*3.2.1 Indications*

*Management of Ascending Aorta Calcification in Coronary Artery Bypass Grafting*

is higher. Therefore, the use of no-clamp aortic proximal anastomotic device can reduce the cerebrovascular complications caused by aortic atherosclerosis.

The Heartstring proximal anastomosis system is suitable for the proximal anastomosis of the graft and the aorta without the use of aortic clamp in CABG [16–17]. The first generation of Heartstring proximal anastomosis system was launched by Guidant Company in 2002 and the most commonly used Heartstring III was launched by MAQUET after continuous technical improvement. The American Thoracic Surgery study [18] of 1380 patients with aortic calcification found that the predicted risk of stroke in patients using Heartstring was reduced by 44%, especially

in patients with aortic calcification above grade II (**Figure 3**).

**3.1 Device composition of Heartstring proximal anastomosis system**

device, conveying device, loading device and aortic perforator device. The Heartstring anastomotic device enters the aorta through the aortic incision established by the aortic drilling device and provides an anastomotic area for proximal anastomosis. The conveyor is a syringe-like tube with a piston, which is used to place the Heartstring anastomosis device into the aorta. The loading device is used to roll up the Heartstring anastomosis device and load the Heartstring anastomosis device into the conveyor. The aortic perforator device is a disposable device, which consists of a handle, a drilling device, an aortic block, a cover, a needle, a safety lock and an action button, which is used to establish an aortic incision for anastomosis.

**3.2 Indications and contraindications of Heartstring technology**

Heartstring proximal anastomotic system consists of proximal anastomotic

For patients with high risks of atherosclerosis, the possibility of ascending aortosclerosis is increased, and the operation of aorta needs to be reduced or avoided. A strict aortic non-touch technique can most effectively reduce the occurrence of plaque embolism. This requires the use of an auxiliary device for proximal aortic anastomosis. The Heartstring proximal anastomotic system is adopted in CABG to

*DOI: http://dx.doi.org/10.5772/intechopen.91909*

**3. Heartstring technique**

*Management of Ascending Aorta Calcification in Coronary Artery Bypass Grafting DOI: http://dx.doi.org/10.5772/intechopen.91909*

is higher. Therefore, the use of no-clamp aortic proximal anastomotic device can reduce the cerebrovascular complications caused by aortic atherosclerosis.
