Six-Month Healing of the Nonocclusive Coronary Anastomotic Connector in an Off-Pump Porcine Bypass Model

Stecher, David MD*; Agostoni, Pierfrancesco MD, PhD; Pasterkamp, Gerard MD, PhD; Hoefer, Imo E. MD, PhD; van Herwerden, Lex A. MD, PhD*; Buijsrogge, Marc P. MD, PhD*

Innovations: Technology & Techniques in Cardiothoracic & Vascular Surgery:
doi: 10.1097/IMI.0000000000000055
Original Articles
Abstract

Objective: This pilot study evaluates the anastomotic healing of the Excimer Laser Assisted Nonocclusive Anastomosis coronary connector at 6 months in a porcine off-pump coronary artery bypass (OPCAB) model.

Methods: Left internal thoracic artery to left anterior descending coronary artery bypass in two animals and left internal thoracic artery to left anterior descending coronary artery and right internal thoracic artery to right coronary artery bypasses in one animal were evaluated intraoperatively and at 6 months. The anastomoses (n = 4) were examined by angiography, intravascular ultrasound, optical coherence tomography, scanning electron microscopy, and histology.

Results: At follow-up, all anastomoses (n = 4) were fully patent (FitzGibbon grade A). Scanning electron microscopy demonstrated complete endothelial coverage of the anastomotic surface, and histology showed minimal streamlining intimal hyperplasia. The in vivo intravascular ultrasound and optical coherence tomography acquisitions confirmed histologic findings. Optical coherence tomography demonstrated 0.06-mm intimal coverage of the intraluminal part of the connector along the full circumference of the anastomosis.

Conclusions: In this pilot study, the Excimer Laser Assisted Nonocclusive Anastomosis coronary connector showed an excellent healing response on the long-term in the porcine OPCAB model. Hence, this new concept might be a potential alternative to hand-sutured anastomosis in (minimally invasive) OPCAB surgery.

Author Information

From the Departments of *Cardiothoracic Surgery, †Cardiology, and ‡Experimental Cardiology, Heart and Lungs Division, University Medical Center Utrecht, Utrecht, The Netherlands.

Accepted for publication December 17, 2013.

Presented the 2013 President’s Award (Cardiac) at the Annual Scientific Meeting of the International Society for Minimally Invasive Cardiothoracic Surgery, June 12–15, 2013, Prague, Czech Republic.

Supported by the University Medical Center Utrecht, ELANA b.v., and Eurostars EUREKA, project NewHeart (ESTAR10210), Utrecht, The Netherlands.

Disclosures: David Stecher, MD, and Marc P. Buijsrogge, MD, PhD, are registered as coinventors of patents regarding the ELANA technique, without personal financial benefits. Lex A. van Herwerden, MD, PhD, is a consultant for St. Jude Medical, Inc, St Paul, MN USA. Pierfrancesco Agostoni, MD, PhD; Gerard Pasterkamp, MD, PhD, and Imo E. Hoefer, MD, PhD, declare no conflicts of interest.

Address correspondence and reprint requests to David Stecher, MD, Department of Cardiothoracic Surgery, University Medical Center Utrecht, Room E03.511, PO Box 85500, 3508 GA Utrecht, The Netherlands. E-mail: dsteche2@umcutrecht.nl.

©2014 by the International Society for Minimally Invasive Cardiothoracic Surgery