Lack of durability of surgical arterialization of coronary veins for the treatment of ischemic heart disease.
OBJECTIVE
Coronary venous arterialization with a catheter-based system has renewed interest in this therapy for the revascularization of areas that cannot be treated by conventional coronary artery bypass graft or angioplasty. However, the durability of the venous system to supply arterial pulsatile blood is still a matter of debate.


METHODS
We report the outcome of four patients that underwent elective coronary artery bypass grafting of the left coronary system and in addition had selective arterialization of the posterior vein due to ungraftable poor distal vessels of the right coronary artery. Complete revascularization of the left side was achieved using the left internal mammary artery and the left radial artery. One vein graft was anastomosed to the postero-inferior vein in three cases and to two postero-inferior veins in the fourth case.


RESULTS
No perioperative complications were observed and after 24 months of follow-up; all patients were angina free and without any symptoms of heart failure. The 24 months follow-up also showed (i) normal exercise test in all patients, (ii) ischemic changes in dobutamine stress echocardiography in the areas corresponding with the venous arterialization in two cases, and (iii) occlusion of the graft supplying the coronary veins in the three patients that accepted to undergo selective angiogram.


CONCLUSIONS
In conclusion, these results indicate that arterialization of the coronary veins is not durable and that it is unlikely that this strategy is a useful technique for the revascularization of the ischemic myocardium.
Department of Integrative Human Cardiovascular Physiology and Cardiac Surgery, Glenfield Hospital, University of Leicester, UK.
Mohammed F
MF
Chowdhry
Joan
J
Davies
Alastair
A
McCance
Manuel
M
Galiñanes
D000368:Aged; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000601:surgery*; D003331:Coronary Vessels / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods*; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome