Evaluation of the PAS-Port Proximal Anastomosis System in coronary artery bypass surgery (the EPIC trial)

Abstract

The PAS-Port proximal anastomotic device produces an effective anastomosis with a 9-month patency rate that is comparable with that of a hand-sewn anastomosis. It allows for construction of a proximal anastomosis without aortic clamping and requires less time than a hand-sewn anastomosis.

Morphological Evaluation of Proximal Anastomosis by PAS-Port^® System in Patients with Long-Term Patent Grafts

“…For anastomosis in coronary artery bypass procedures, various proximal and distal anastomotic devices have been devised and clinical data obtained using these devices have been analyzed. 4,9,10) However, there is still little evidence on factors influencing long-term results and graft patency. Concerning proximal aortic anastomosis in OPCAB, partial clamp of the aorta was considered to be necessary and the risks of cerebral infarction onset and injury to the aortic wall were initially of major concern.…”

“…The merits of the proximal anastomotic PAS-Port ® system device include the duration of surgery being shortened to facilitate prevention of cerebral infarction without aortic clump. 4) Furthermore, PAS-Port ® system can easily be used regardless of expertise, and is now in widespread use. There are reports of its application in patients with marked calcification and sclerosis of the aorta, as well as in the thoracic descending aorta in patients undergoing re-operation.…”

“…The examination of proximal anastomosis angle and morphology were reported, 4,7,15) but the long term evidence are un-regarding the angle of the graft to the aortic wall, even if the angle was acute, there appeared to be no risk of occlusion so long as the graft lumen was maintained. Because the graft was anastomosed perpendicularly to the aortic wall, a characteristic of anastomosis by PAS-Port ® system, stenosis via the natural flexion of the graft at the proximal site was considered to be unlikely.…”

“…It has been reported that some good results on short and mid-term patency of PAS-Port ® system. [4][5][6][7] In this study, rather than to examine the patency of the SVG itself, showed a long-term safety proximal anastomosis device. Continued future, long-term follow-up is a necessity.…”

“…3) Introduction of automatic anastomotic devices in Japan began with the approval of the PAS-Port ® system (Cardica, Inc., Redwood City, California, USA) in 2006. The usefulness of PAS-Port ® system has been reported by various authors, [4][5][6][7] but the long-term results of its use have not yet been studied in Japan. We report the results of our morphological study of graft proximal anastomosis with the use of PAS-Port ® system, on both short and long-term graft patency, employing multidetector computed tomography (MDCT).…”