Percutaneous approach to a stent-based ventricle to coronary vein bypass (venous VPASS): comparison to catheter-based selective pressure-regulated retro-infusion of the coronary vein.
OBJECTIVE
Percutaneous stent-based ventricle-to-coronary vein bypass (venous VPASS) is a new approach to chronic venous arterialization as a treatment modality in an otherwise no option patient with coronary artery disease. In this study, the efficacy of venous VPASS was compared with catheter-based selective pressure-regulated retro-infusion of arterial blood during acute ischaemia.


RESULTS
In seven pigs, venous VPASS was established using a percutaneous ultrasound-guided puncture from the anterior cardiac vein to the left ventricle, with subsequent implantation of an ePTFE-covered stent graft. During left anterior descending artery (LAD) occlusion, coronary venous pressure in the distal anterior cardiac vein increased to 55+/-4 mmHg under conditions of venous VPASS compared with 78+/-5 mmHg during selective pressure-regulated retro-infusion. Significant preservation of regional myocardial function was observed during venous VPASS (67+/-6% baseline) and during selective retro-infusion (83+/-4%) compared with control LAD occlusion (0.4+/-2%).


CONCLUSIONS
Percutaneous implantation of a PTFE covered stent (venous VPASS) was feasible and associated with significant preservation of regional myocardial function during acute ischaemia in pigs at reasonable levels of mean coronary venous pressure to avoid tissue damage during chronic application.
Raake
Philip
P
Department of Internal Medicine I, Grosshadern University Hospital, Marchioninistr. 15, D-81377 Munich, Germany.
Hinkel
Rabea
R
Kupatt
Christian
C
von Brühl
Marie-Luise
ML
Beller
Sabrina
S
Andrees
Martin
M
Vicol
Calin
C
Boekstegers
Peter
P
D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D000818:Animals; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods; D006328:Cardiac Catheterization; D001026:Coronary Artery Bypass / Q000379:methods*; D003331:Coronary Vessels; D006352:Heart Ventricles; D017202:Myocardial Ischemia / Q000628:therapy*; D009204:Myocardial Revascularization / Q000379:methods*; D011897:Random Allocation; D015607:Stents; D013552:Swine; D014680:Veins