Preclinical Comparison of Distal Off-Pump Anastomotic Remodeling: Hand-Sewn Versus ELANA Heart Bypass

Figures

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  Fig. 1.. Flowchart of inclusions. The original sample is projected above and the complete sample below the dotted line. Follow-up in days shown in subscript.

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  Fig. 2.. The 2 different ELANA Heart Clip prototypes. The improved spring body of the V3 prototype ELANA Heart Clip (left) enables optimal delivery of spring force onto the pins of the clip. This design change results in a larger and 20% heavier V3 prototype (left) compared with the previous V2 prototype (right).

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  Fig. 3.. Healing tendency of the ELANA Heart Bypass anastomosis. SEM (left) and light microscopy (right) images of the mid-anastomotic joining line at various follow-up durations. SEM images depict part of the anastomotic rim and titanium pins (*) at shorter follow-up and neointima at longer follow-up durations (#). The anastomotic opening is dark colored (O). Light microscopy images depict transverse sections, mid-anastomosis. The titanium clip parts are black, the squares are transected upper and lower forks (UF and LF), and the rectangles are transected mid-ring (R). LIMA is depicted above and LAD below. The black dots and thin horizontal are artifacts. (a, b) 4 hours postoperative; (c, d) 4 days postoperative; (e, f) 10 days postoperative; (g, h) 14 days postoperative; (i, j) 35 days postoperative. LAD, left anterior descending artery; LIMA, left internal mammary artery; SEM, scanning electron microscopy.

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  Fig. 4.. Intima hyperplasia and mid-anastomotic diameter at the end of follow-up. Measurements (in µm, mid-anastomosis, H&E stained slides) are depicted per follow-up term and represent n = 1 pig for the follow-up terms up to 35 days and a mean (n = 5–8 pigs) for the 90-day follow-up. No data are available for the ELANA 14-day follow-up since the anastomosis analyzed was not patent.

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  Fig. 5.. Inflammatory cell density at the end of follow-up. Count of well-defined nuclei in 6 predefined areas (24 fields) near the mid-anastomotic joining line in H&E stained slides (400× magnification). Measurements are depicted per follow-up term and represent n = 1 pig for the follow-up terms up to 35 days and a mean (n = 3 pigs) for the 90-day follow-up.