David Stecher1, Marieke Hoogewerf2,3, Glenn Bronkers3, Bart P van Putte4,5, Pieter A Doevendans2,6, Cornelis A F Tulleken3,7, Lex van Herwerden1, Gerard Pasterkamp8, Marc P Buijsrogge1. 1. 8124 Department of Cardiothoracic Surgery, University Medical Center Utrecht, The Netherlands. 2. 8124 Department of Cardiology, University Medical Center Utrecht, The Netherlands. 3. AMT Medical Research B.V., Utrecht, The Netherlands. 4. 6028 Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands. 5. Department of Cardiothoracic Surgery, Amsterdam University Medical Center, The Netherlands. 6. Netherlands Heart Institute, Utrecht, The Netherlands. 7. 8124 Department of Neurosurgery, University Medical Center Utrecht, The Netherlands. 8. 8124 Department of Experimental Cardiology, University Medical Center Utrecht, The Netherlands.
Abstract
OBJECTIVE: This preclinical study determines the feasibility and 6-month patency rates of a new distal coronary connector, the Excimer Laser Assisted Nonocclusive Anastomosis (ELANA) Heart Bypass. METHODS: Twenty Dutch Landrace pigs received either a hand-sewn (n = 8) or an ELANA (n = 12) left internal thoracic artery to left anterior descending artery anastomosis, using off-pump coronary artery bypass grafting. Six-month patency rates were demonstrated by coronary angiography and histological evaluation. Throughout, procedural details and complication rates were collected. RESULTS: The ELANA Heart Bypass demonstrated 0% mortality and complication rates during follow-up. It was demonstrated feasible, with comparable perioperative flow measurements (ELANA vs hand-sewn, median [min to max], 24 [14 to 28] vs 17 [12 to 31] mL/min; P = 0.601) and fast construction times (3 [3 to 7] vs 31 [26 to 37] min; P < 0.001). Yet, an extra hemostatic stitch was needed in 25% of the ELANA versus 12.5% of the hand-sewn anastomoses. The 6-month patency rate of the ELANA Heart Bypass was 83.3% versus 100% in hand-sewn anastomoses. The 2 occluded ELANA-anastomoses were defined model-based errors. CONCLUSIONS: The ELANA Heart Bypass facilitates a sutureless distal coronary anastomosis. A design change is suggested to improve hemostasis and will be evaluated in future translational studies. This new technique is a potential alternative to hand-sewn anastomoses in (minimally invasive) coronary surgery.
OBJECTIVE: This preclinical study determines the feasibility and 6-month patency rates of a new distal coronary connector, the Excimer Laser Assisted Nonocclusive Anastomosis (ELANA) Heart Bypass. METHODS: Twenty Dutch Landrace pigs received either a hand-sewn (n = 8) or an ELANA (n = 12) left internal thoracic artery to left anterior descending artery anastomosis, using off-pump coronary artery bypass grafting. Six-month patency rates were demonstrated by coronary angiography and histological evaluation. Throughout, procedural details and complication rates were collected. RESULTS: The ELANA Heart Bypass demonstrated 0% mortality and complication rates during follow-up. It was demonstrated feasible, with comparable perioperative flow measurements (ELANA vs hand-sewn, median [min to max], 24 [14 to 28] vs 17 [12 to 31] mL/min; P = 0.601) and fast construction times (3 [3 to 7] vs 31 [26 to 37] min; P < 0.001). Yet, an extra hemostatic stitch was needed in 25% of the ELANA versus 12.5% of the hand-sewn anastomoses. The 6-month patency rate of the ELANA Heart Bypass was 83.3% versus 100% in hand-sewn anastomoses. The 2 occluded ELANA-anastomoses were defined model-based errors. CONCLUSIONS: The ELANA Heart Bypass facilitates a sutureless distal coronary anastomosis. A design change is suggested to improve hemostasis and will be evaluated in future translational studies. This new technique is a potential alternative to hand-sewn anastomoses in (minimally invasive) coronary surgery.
Authors: David Stecher; Marieke Hoogewerf; Bart P van Putte; Shadan Osman; Pieter A Doevendans; Cornelis Tulleken; Lex van Herwerden; Gerard Pasterkamp; Marc P Buijsrogge Journal: Innovations (Phila) Date: 2022-03-17
Authors: Marieke Hoogewerf; Jeroen Schuurkamp; Johannes C Kelder; Stephan Jacobs; Pieter A Doevendans Journal: J Clin Med Date: 2022-01-29 Impact factor: 4.241