Percutaneous in situ venous arterialisation.
About 5% of patients annually have no acceptable therapeutic option because of diffuse coronary disease without a discrete target for angioplasty, stenting or surgical bypass. Retrograde perfusion of the myocardium via the venous system was successfully performed by cardiac surgeons before the widespread use of coronary artery bypass grafting and has been applied in "ungraftable" patients since. Percutaneous in situ venous arterialisation (PICVA) follows this surgical experience, using a series of unique catheter-based devices to arterialise isolated segments of coronary vein to provide retrograde perfusion of the ischaemic myocardium. In a series of animals this procedure had been shown to reduce ischaemia and myocardial damage in an infarction model. In the PICVA European Safety trial, the first eleven percutaneous applications of catheter-based, coronary bypass in humans revealed feasibility of the technique in highly symptomatic, non-option patients. Despite two deaths and six failures to create a connection, we continue to believe that upon further development, the catheter-based veno-arterial coronary bypass can become an option in inoperable and undilatable patients.
Reifart
Nicolaus
N
Main Taunus Heart Institute, Bad Soden, Germany. n.reifart@reifart-partner.de
D015906:Angioplasty, Balloon, Coronary; D000818:Animals; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D000075202:Contraindications; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000401:mortality / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D003326:Coronary Circulation; D003331:Coronary Vessels / Q000473:pathology / Q000503:physiopathology*; D006801:Humans; D016896:Treatment Outcome; D014680:Veins / Q000503:physiopathology