PROXIMAL ANASTOMOSIS DEVICE Manipulation of the ascending aorta during cardiac surgery is one of the leading causes of embolic events and postoperative stroke; atheromatous disease of the ascending aorta is more prevalent in the elderly population.5,6 Evolving technologies of proximal anastomosis devices tested the ability to serve the goal of surgeons to minimize manipulation of the ascending aorta during surgical myocardial revascularization, as emboli generated

during cardiac surgery have been associated with aortic clamping Inhibitors,research,lifescience,medical and manipulation. At first, proximal anastomotic devices were thought to be less traumatic by eliminating partial clamping, potentially resulting in fewer adverse outcomes; however, their use has ceased due to

the accumulation of substantial discouraging PDE inhibitor evidence. Inhibitors,research,lifescience,medical In 2004, Martens et al. compared the amount of debris released using intra-aortic filtration and the clinical outcomes between conventionally hand-sewn and automated Inhibitors,research,lifescience,medical proximal anastomoses.5 This comparison was carried out through the investigation of 77 patients undergoing primary CABG with cardiopulmonary bypass in a prospective randomized study. Patients were assigned to the anastomotic device Group I (Symmetry Aortic Connector, St. Jude Medical, Inc., St. Paul, MN, USA; n = 39) or the conventional hand-sewn anastomosis control Group II (n = 38). Proximal

anastomoses were performed before cardiopulmonary bypass in both groups. Intra-aortic Filter 1 (EMBOL-X, Edwards Lifesciences LLC, Irvine, CA, USA) was deployed prior to partial clamping Inhibitors,research,lifescience,medical or puncturing the aorta for device application and removed after the proximal anastomosis was completed. Prior to cross-clamp removal, a second filter was inserted (Filter 2). A core laboratory performed quantitative Inhibitors,research,lifescience,medical and histologic analyses of the debris captured. Martens et al. demonstrated that preoperative variables and risk factors were not significantly different between Groups I and II (European System for Cardiac Operative Risk Evaluation (EuroSCORE) 3.9 ± 2.6 versus 4.2 ± 2.5, respectively). Filter analyses showed no significant difference between Groups I and II in Filter 1 or 2 for either surface area of particles or total number of TCL particles. A decrease was observed between Filters 1 and 2 in both groups for surface area of particles (Group I: 18.5 ± 23.8 mm2 versus 10.7 ± 16.3 mm2, P = 0.017; Group II: 15.0 ± 15.4 mm2 versus 6.9 ± 6.5 mm2, P = 0.004), and for total number of particles in Group II (8.6 ± 3.7 versus 7.1 ± 2.4, P = 0.023). No significant differences were observed between Group I (device) and Group II (control) outcomes for myocardial infarction, neurocognitive deficit, stroke, length of stay, graft occlusion, or mortality.