Selective arterialization of a cardiac vein in a model of cardiac microangiopathy and macroangiopathy in sheep.
OBJECTIVE
Some patients with significant arteriosclerosis of the heart are not amenable to revascularization of a coronary artery because they have a combination of microangiopathy and significant macroangiopathy. We investigated the benefit of arterialization of a cardiac vein under these circumstances in an acute animal model.


METHODS
In the hearts of 8 sheep, microspheres were injected into the left coronary artery; 60 minutes later, a stenosis of the left anterior descending artery was performed. After 45 minutes, retrograde venous revascularization was performed by sewing the left internal thoracic artery to the concomitant vein of the left anterior descending artery in a beating-heart technique. For flow reversal, the vein was ligated proximally to the anastomosis. The efficiency of the bypass graft was evaluated by coronary angiography and flow measurement. Cardiac output, electrocardiography, and mean arterial blood pressure were assessed in each phase of the experiment.


RESULTS
The ischemic state of the myocardium was confirmed by a significant decrease of cardiac output, stroke volume, and mean arterial blood pressure, and a significant elevation of the ST segment in the electrocardiography. After retrograde venous revascularization was established, cardiac output and stroke volume increased and ST elevations decreased. The grafts showed adequate flow (26.15 +/- 2.08 mL/min), and reversed blood flow in the grafted vein was proved by coronary angiography.


CONCLUSIONS
Retrograde venous revascularization is possible and improves cardiac function in a state of acute ischemia caused by a combination of microangiopathy and macroangiopathy.
Resetar
Michaela Elisabeth
ME
Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany. michaela.resetar@med.uni-leipzig.de
Ullmann
Cris
C
Broeske
Petra
P
Ludwig-Schindler
Kristin
K
Doll
Nicolas K
NK
Salameh
Aida
A
Dhein
Stefan
S
Mohr
Friedrich W
FW
D000818:Animals; D001794:Blood Pressure; D002302:Cardiac Output; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D003402:Creatine Kinase / Q000097:blood; D004562:Electrocardiography; D005260:Female; D006339:Heart Rate; D008297:Male; D009204:Myocardial Revascularization / Q000379:methods*; D034561:Sheep, Domestic; D013318:Stroke Volume; D014680:Veins / Q000601:surgery
D003402:Creatine Kinase