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John D. Puskas
Michael E. Halkos
Husam Balkhy
Michael Caskey
Mark Connolly
John Crouch
Anno Diegeler
Jan Gummert
Wolfgang Harringer
Valavanur Subramanian
Francis Sutter
Klaus Matschke
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J Thorac Cardiovasc Surg 2009;138:125-132
© 2009 The American Association for Thoracic Surgery

Evolving Technology/Basic Science

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

John D. Puskas, MDa,*, Michael E. Halkos, MDa, Husam Balkhy, MDb, Michael Caskey, MDc, Mark Connolly, MDd, John Crouch, MDe, Anno Diegeler, MD, PhDf, Jan Gummert, MD, PhDg, Wolfgang Harringer, MDh, Valavanur Subramanian, MDi, Francis Sutter, DOj, Klaus Matschke, MD, PhDk EPIC Trial Investigators

a Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
b Department of Cardiothoracic and Cardiovascular Surgery, the Wisconsin Heart Hospital, Milwaukee, Wis
c Scottsdale Healthcare Medical Center, Scottsdale, Ariz
d Division of Cardiovascular and Thoracic Surgery, St Michael's Medical Center, Newark, NJ
e Department of Cardiovascular and Thoracic Surgery, St Luke's Medical Center, Milwaukee, Wis
f Department of Cardiac Surgery, Rhönklinik Bad Neustadt, Bad Neustadt, Germany
g Department of Cardiac and Thoracic Surgery, Herzzentrum Jena University, Jena, Germany
h Department of Cardiac, Thoracic, and Vascular Surgery, Klinik für Herz-, Thorax- und Gefäßchirurgie, Städtisches Klinikum Braunschweig GmbH, Hannover, Germany
i Department of Cardiothoracic Surgery, Lenox Hill Hospital, New York, NY
j Department of Cardiovascular and Thoracic Surgery, Mainline Heart Health Center, Wynnewood, Pa
k Department of Cardiac Surgery, Herzzentrum Dresden, Dresden, Germany

Received for publication November 2, 2008; revisions received January 10, 2009; accepted for publication February 2, 2009.

* Address for reprints: John D. Puskas, MD, Division of Cardiothoracic Surgery, Emory University School of Medicine, 550 Peachtree St, Crawford Long Hospital, 6th Floor, Medical Office Tower, Atlanta, GA 30308. (Email: john.puskas{at}emoryhealthcare.org).

Objective: During coronary surgery, proximal vein graft anastomoses have been performed by using an aortic partial occlusion clamp to allow for a hand-sewn anastomosis. The purpose of this multicenter, prospective, randomized trial was to evaluate the efficacy of the PAS-Port device (Cardica, Inc, Redwood City, Calif), which allows an automated proximal anastomosis to be performed without aortic clamping.

Methods: Between June 22, 2006, and March 22, 2007, 220 patients requiring coronary artery bypass grafting with at least 2 vein grafts were enrolled. Within each patient, 1 graft was randomly assigned to receive a PAS-Port device, and the other was assigned to receive a hand-sewn anastomosis to the ascending aorta. The primary end point was angiographic patency (<50% stenosis) 9 months after surgical intervention. Secondary end points included average time to complete each anastomosis and 9-month freedom from major adverse cardiac events.

Results: One hundred eighty-three patients received matched grafts that were angiographically assessed at 9 months. The 9-month graft patency was 82.0% (150/183) for hand-sewn and 80.3% (147/183) for PAS-Port grafts. The patency rate of PAS-Port anastomoses was statistically noninferior to that of hand-sewn anastomoses (95% lower confidence limit for difference, –7.95%). The freedom from major adverse cardiac events at 9 months was 97.7% for PAS-Port (95% confidence interval, 94.5%–99.0%) and 98.2% for hand-sewn (95% confidence interval, 95.1%–99.3%) grafts. The PAS-port device was associated with a 4.6 ± 3.9–minute reduction in anastomotic time compared with that seen with a hand-sewn anastomosis (P < .001).

Conclusions: 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.

Abbreviations and Acronyms FDA = US Food and Drug Administration; MACE = major adverse cardiac event






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