[21-23] In this study we wanted to introduce a new, modified end-to-side technique, the opened end-to-side (OES-) technique, which was rheologically analyzed in a Bortezomib mouse previously described circulatory, simulative

model[24] and compared it to a conventional technique for end-to-side anastomosis. We performed two different types of end-to-side anastomoses (conventional technique vs. Opened End-to-Side technique) using forty pig coronary arteries from domnestic pigs (type Ländle Alpschwein, Austria, mean weight 130 kg) and produced true-to-scale silicone rubber model in two equal groups using each one of the technique. The pigs were slaughtered and coronary vessels were gained after explantations of the hearts by microsurgical dissection under the microscope. Each 20 arteries were used for each technique, resulting in 40 specimen of An experimental,

cardiovascular setup was created and Laser-Doppler-Anemometry measurements, recording seven heart cycles at four defined measurement planes in each model were performed. The key feature of the Opened-End-to-Side (OES) technique was the preparation of the end of the branching vessel (e.g., arterial pedicle). It was cut in a special way, resulting in a bi-triangular pedicle end. First, two parallel longitudinal slits were located at 180° and the vessel was divided in an anterior and posterior part. The resulting branching angle was adjustable by varying length and angle of the two parallel, isochronous slits. Finally, two symmetric triangules were cut of each vessel half and the prepared vessel end got its typical opened heptaminol end, reminding one of a fish mouth (Fig. 1). Following the INK 128 in vitro preparation, first the points A-A′, B-B′ (beginning and end of the vesselotomy and its corresponding point of the branching vessel) and C-C′ (half way of the vesseotomy and its corresponding point of the branching vessel) were aligned and anastomosed by interrupted sutures. When these stitches had been placed, the remainder were placed proximally and distally to the

previous sutures until the anastomosis of the posterior wall was completed. Then, the single clamp of the branching vessel was turned over and revealed the previously sutured posterior wall from an intraluminal perspective. After visual control, the completion of the anterior wall was started. D-D′ (half way of the vesseotomy and its corresponding point of the branching vessel) were aligned and the end-to-side anastomosis was completed using interrupted sutures (Fig. 1). In the experimental anastomosis a branching angle of ∼60° was achieved. For the model of the conventional technique we used the technique according to the description of Hall et al.[9] The vessel end of the branching vessel was cut oblique with the micro-scissor in an angle of ∼70°. The “side window” of the main vessel was achieved by ellipse arteriotomy. The anastomosis was accomplished by interrupted sutures.