Intramyocardial left ventricle-to-coronary artery stent: a novel approach for the treatment of coronary artery disease.
BACKGROUND
The direct intramyocardial left ventricle-to-coronary artery stent may provide an optional minimally invasive technique for coronary artery bypass graft surgery. We seek to test whether blood flow and regional myocardial function improve with this stent in totally ischemic myocardium.


METHODS
The stent device was implanted in 8 anesthetized dogs using an open chest approach, arteriotomy of the proximal left anterior descending coronary artery, and connection of the vessel to the left ventricular chamber. Regional coronary blood flow and myocardial function were monitored under three conditions: normal coronary flow (baseline), coronary ligation, and stent flow.


RESULTS
Left anterior descending coronary ligation markedly reduced coronary artery blood flow and regional myocardial function. With flow solely from the stent, the blood flow pattern changed to one with high peak forward flow during systole compared with baseline (94.8 +/- 48.9 versus 56.8 +/- 21.1 mL/min; p < 0.05) and one with significant negative backflow during diastole compared with baseline (-37.4 +/- 23.1 versus 11.3 +/- 17.2 mL/min; p < 0.05). However, the resultant mean forward flow increased to approximately 50% of baseline compared with less than 5% of baseline after coronary ligation. Regional myocardial function diminished entirely after coronary ligation, but recovered to approximately 60% of baseline with the stent. Normal systemic hemodynamics and global ventricular contractile function were maintained with the stent.


CONCLUSIONS
The left ventricle-to-coronary artery stent is a simple and readily deployable device that allows the perfusion of epicardial vessels directly from the left ventricle and can provide significant blood flow to improve the performance of ischemic myocardium. It may provide an effective, alternative means of treating coronary artery disease when standard coronary artery bypass graft surgery is not suitable.
Yi
Geng-Hua
GH
Division of Cardiology, Department of Medicine, Columbia University, College of Physicians and Surgeons, New York, New York 10032, USA.
Becker
Eva Maria
EM
Dang
Nicholas C
NC
He
Kun-Lun
KL
Cahalan
Patrick
P
Gu
Anguo
A
Lee
Myung Jae
MJ
Yue
Kenward
K
Burkhoff
Daniel
D
Wang
Jie
J
D000818:Animals; D006348:Cardiac Surgical Procedures / Q000295:instrumentation*; D003326:Coronary Circulation; D023921:Coronary Stenosis / Q000601:surgery*; D003331:Coronary Vessels; D004195:Disease Models, Animal; D004285:Dogs; D005260:Female; D006352:Heart Ventricles; D008026:Ligation; D008297:Male; D017202:Myocardial Ischemia / Q000601:surgery; D015607:Stents