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

Objectives The ELANA® Heart Bypass creates a standardized sutureless anastomosis. Hereby, we investigate the influence of arteriotomy and graft size on coronary hemodynamics. Methods A computational fluid dynamics (CFD) model was developed. Arteriotomy size (standard 1.43 mm 2 ; varied 0.94 – 3.6 mm 2 ) and graft diameter (standard 2.5 mm; varied 1.5 – 5.0 mm) were independent parameters. Outcome parameters were coronary pressure and flow, and fractional flow reserve (FFR). Results The current size ELANA (arteriotomy 1.43 mm 2 ) presented an estimated FFR 0.65 (39 mL/min). Enlarging arteriotomy increased FFR, coronary pressure, and flow. All reached a maximum once the arteriotomy (2.80 mm 2 ) surpassed the coronary cross-sectional area (2.69 mm 2 , i.e. 1.85 mm diameter), presenting an estimated FFR 0.75 (46 mL/min). Increasing graft diameter was positively related to FFR, coronary pressure, and flow. Conclusion The ratio between the required minimal coronary diameter for application and the ELANA arteriotomy size effectuates a pressure drop that could be clinically relevant. Additional research and eventual lengthening of the anastomosis is advised. Graphical abstract