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OBJECTIVE:
To further facilitate minimal access coronary artery bypass surgery, a reliable and simplified alternative for hand-sutured coronary anastomosis has to be developed. The ELANA (Excimer Laser Assisted Non-occlusive Anastomosis) technique is a non-occlusive, facilitated bypass technique that is FDA-approved for clinical application in neurosurgery. This study evaluates a new sutureless ELANA-based prototype coronary anastomotic connector. Patency, anastomotic healing, remodeling and hemodynamic function were assessed in the acute and mid-term follow-up in a pig coronary bypass model.

METHODS:
In the porcine model (n=12 animals), left internal thoracic artery (LITA) to left anterior descending (LAD, outer diameter 3 mm) coronary bypasses were evaluated intraoperatively (n=12 anastomoses) and at 4 hours, 4 days, 10 days, 2 weeks, 3 weeks and 5 weeks (each subgroup n=2 anastomoses). The anastomoses were examined by flow measurement, angiography and histology.

RESULTS:
The ELANA-connector enabled fast (mean 7,6 ± 2,4 minutes) anastomosis construction. In all anastomoses (n=12) complete hemostasis was demonstrated and all anastomoses (n=12) were fully patent (FitzGibbon grade A) at follow-up. Mean peak hyperemic flow response was 4,4 (see table). In all anastomoses the intima of the LITA was opposed to the adventitia of the LAD. At 5-weeks follow-up, a streamlined cover of endothelium was observed along the full circumference of the anastomosis.

LITA-LAD flow (mL/min; mean ± SD)
n=12	34 ± 8
Peak hyperemic flow response (peak [following 30 second-graft occlusion]/base flow; mean ± SD)
n=12	4,4 ± 0,8

CONCLUSIONS:
The ELANA coronary connector is easy-to-use, safe and feasible in the porcine off-pump bypass model. Safety and quality on the long-term still have to be assessed. Hence, this facilitated non-occlusive coronary bypass technique might have potential for minimally invasive coronary bypass surgery.