Adaptable Seal Minimizes Aortic Manipulation During Anastomosis

A novel sealing system minimizes aortic manipulation during on and off-pump coronary artery bypass grafting (CABG).

The Vascular Grafts Solutions (VGS; Tel Aviv, Israel) Viola is a clampless proximal anastomosis system that combines a standard punching mechanism and an adjustable sealing element that accommodates to the aortic wall, creating an optimal seal with minimal bleeding. Viola is also suitable for multiple use, allowing surgeons to create three to four anastomosis with a single unit. The result is protected, clean, and dry proximal anastomosis suturing of the aorta during CABG without partial clamping, which can lead to neurologic complications.


“Our vision has always been to advance cardiovascular surgery. We are committed to this long journey and in the last decade, we were able to develop solutions that address the biggest unmet needs in CABG, vein graft failure and perioperative neurological complications,” said Eyal Orion, MD, founder and CEO of VGS. “Gradually, our focus will shift from generating high quality science that shows the benefits of our technologies to making our solutions a new standard of care in CABG.”

“The Viola has important design features that provide reliable and safe mechanism for constructing clampless proximal anastomoses,” said Professor Gil Bolotin, MD, director of cardiac surgery at Rambam Medical Center (Haifa, Israel). “The integrated punching mechanism, the excellent sealing quality which makes a blower unnecessary, and the ability to perform multiple anastomoses with a single device makes the Viola a very attractive tool in our operating room.”

Atherosclerosis of the ascending aorta is known to be a major source for post-operative stroke and cognitive dysfunction following CABG, since the manipulation of diseased aorta (either by cannulation or cross clamping) can lead to release of atherosclerotic material and calcified plaque that can potentially cause neurologic complications. Clampless proximal anastomosis can help prevent postoperative stroke and neurologic events, especially in patients with high grade aortic stenosis.

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