Evaluating the Arteriotomy Size of a New Sutureless Coronary Anastomosis Using a Finite Volume Approach.

Abstract

The ELANA® Heart Bypass creates a standardized sutureless anastomosis. Hereby, we investigate the influence of arteriotomy and graft size on coronary hemodynamics. A computational fluid dynamics (CFD) model was developed. Arteriotomy size (standard 1.43mm2; varied 0.94-3.6mm2) and graft diameter (standard 2.5mm; varied 1.5-5.0mm) were independent parameters. Outcome parameters were coronary pressure and flow, and fractional flow reserve (FFR). The current size ELANA (arteriotomy 1.43 mm2) presented an estimated FFR 0.65 (39mL/min). Enlarging arteriotomy increased FFR, coronary pressure, and flow. All reached a maximum once the arteriotomy (2.80 mm2) surpassed the coronary cross-sectional area (2.69 mm2, i.e. 1.85mm diameter), presenting an estimated FFR 0.75 (46mL/min). Increasing graft diameter was positively related to FFR, coronary pressure, and flow. The ratio between the required minimal coronary diameter for application and the ELANAarteriotomy size effectuates a pressure drop that could be clinically relevant. Additional research and eventual lengthening of the anastomosis is advised.