First clinical experience with the VSTENT: a device for direct left ventricle-to-coronary artery bypass.
BACKGROUND
Stent-based left ventricle-to-coronary artery stent (VSTENT) is a newly developed, alternative surgical revascularization procedure (VCAB). We present here our initial experience using this technique.


METHODS
Twelve patients (10 male and 2 female, mean age 61 +/- 13 years) underwent a VCAB concomitant to coronary artery bypass surgery. Myocardial revascularization was performed on-pump with arrested heart in 4 patients, on-pump with beating heart in 6 patients, and off-pump in 2 patients. Average number of coronary anastomoses per patient was 2.4 +/- 0.8. In all cases left internal thoracic artery-to-left anterior descending was used. In each patient only one VSTENT was implanted. Target artery for the VCAB was a diagonal branch in 5 patients, an intermediate branch in one patient and a marginal branch in 6 patients. Mean time for the VCAB was 23 +/- 5 minutes (17 to 30 minutes).


RESULTS
An immediate procedural success was observed in 11 of 12 cases. In one case VCAB was not successful and conventional aortocoronary bypass was performed. One patient died on the second postoperative day due to a systemic inflammatory response syndrome. Autopsy demonstrated a patent VSTENT. Angiography was performed in 10 patients 2 to 16 days (9 +/- 5 days) postoperatively showing a patent VSTENT in 8 patients.


CONCLUSIONS
The VCAB was feasible and potentially safe in the short-term postoperative follow-up, particularly with increasing experience after the first patients. Though the VSTENT is a promising tool for myocardial revascularization, long-term safety, patency, and performance of the device needs to be determined.
Vicol
Calin
C
Department of Cardiac Surgery, Grosshadern Medical Center, Ludwig-Maximilians-University Munich, Munich, Germany. calin.vicol@med.uni-muenchen.de
Reichart
Bruno
B
Eifert
Sandra
S
Raake
Philip
P
Hinkel
Rabea
R
Steinbeck
Gerhard
G
Boekstegers
Peter
P
D000328:Adult; D000368:Aged; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000295:instrumentation*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000601:surgery; D004452:Echocardiography; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents