The Excimer Laser Assisted Non-occlusive Anastomosis (ELANA) Anastomotic System surgical technique to construct distal anastomoses using a novel device in coronary artery bypass grafting

Coronary artery disease remains a leading cause of morbidity and mortality worldwide. Although coronary artery bypass grafting (CABG) via median sternotomy is the standard treatment for complex multivessel disease, wider adoption of minimally invasive approaches has been limited by the technical difficulty of constructing distal coronary anastomoses on the beating heart. The Excimer Laser Assisted Non-occlusive Anastomosis (ELANA) Anastomotic System is a novel sutureless connector designed to enable reproducible distal anastomoses without interruption of native coronary blood flow. As part of the SAFE-CAB trial, a prospective study evaluating the safety and effectiveness of the ELANA system, we describe the construction of a left internal thoracic artery (LITA) to left anterior descending coronary artery (LAD) anastomosis using this technology. The procedure was performed via median sternotomy in a 63-year-old male with stable angina and two-vessel coronary artery disease. The six-step ELANA technique was executed on the beating heart in a pump-assisted setting. The ELANA-assisted LITA-LAD anastomosis was completed in 20 min, contributing to a total operative time of 185 min. Transit-time flow measurements demonstrated satisfactory graft function, and postoperative recovery was uneventful. Six-month follow-up coronary angiography showed a patent and well-functioning anastomosis, as independently confirmed by cardiology and core laboratory assessment. This case illustrates the feasibility of sutureless, non-occlusive coronary anastomosis using the ELANA system. Ongoing trials and continued device refinement will determine its broader clinical applicability and possibilities in facilitating safe minimally invasive CABG.