Abstract
ObjectiveCardiac vein arterialization is seldom applied for treating right coronary artery disease. This study aimed to improve outcomes of cardiac vein arterialization in a porcine model using intramammary artery anastomosis.MethodsA chronic, stenotic coronary artery model was established in 12 of 14 Chinese experimental miniature pigs of either sex, which were randomly divided into equal control (n = 6) and experimental (n = 6) groups. In experimental animals, blood flow was reconstructed in the right coronary artery using intramammary artery. Arterialization involved dissection of right internal mammary artery from bifurcation to apex of thorax followed by end-to-side anastomosis of internal mammary artery and middle cardiac vein plus posterior descending branch of right coronary artery. Intraoperative heart rate was maintained at 110 beats/min. Graft flow assessment and echocardiography were performed when blood pressure and heart rate normalized.ResultsThe experimental group had significantly higher mean endocardial and epicardial blood flow postoperatively than control group (mean endocardial blood flow: 0.37 vs. 0.14 ml/(g*min), p<0.001; mean epicardial blood flow: 0.29 vs. 0.22, p = 0.014). Transmural blood flow was also higher in experimental group than in control group (0.33 vs. 0.19, p<0.001); ejection fraction increased from 0.46% at baseline to 0.51% (p = 0.0038) at 6 hours postoperatively, and mean blood flow of internal mammary artery was 44.50, perfusion index 0.73 at postoperative 6 months, 43.33 and 0.80 at 3 months.ConclusionSuccessful cardiac vein arterialization via intramammary artery in a porcine model suggests that this may be a viable method for reconstructing blood flow in chronic, severe coronary artery disease.
Highlights
Most patients with chronic or acute coronary artery disease (CAD) are treated with coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI)
Animals’ weights and diffuse coronary artery stenosis rates were comparable in control and selective coronary vein bypass graft (SCVBG) groups
Significantly higher mean blood flow was observed in the endocardium and epicardium of the SCVBG group compared to that in the control group (mean endocardial blood flow: 0.37 vs. 0.14 ml/(g*min), p,0.001; mean epicardial blood flow: 0.29 vs. 0.22, p = 0.014)
Summary
Most patients with chronic or acute (post-myocardial infarct) coronary artery disease (CAD) are treated with coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). Six-year follow-up of PCI with drug-eluting stent implantation for left main coronary artery stenosis revealed acceptable rates of cardiac death, myocardial infarction and stent thrombosis[2]. Patients with refractory angina, including severe diffuse coronary artery stenosis, small caliber coronary artery, and a history of repeated surgeries, cannot undergo CABG or PTCA, and these patients account for 12% to 15% of patients requiring myocardial revascularization therapy[3]. Surgeons and scholars have devised other techniques, including transmyocardial laser revascularization (TMLR)[4], pro-angiogenic gene therapy[5], cardiac denervation surgery, and endarterectomy combined with CABG[6]. Endarterectomy is not suitable for thin blood vessels with lesions, blood vessels with severe distal lesions, or blood vessels with immature plaques[10.] Another method is percutaneous in situ coronary venous arterialization (PICVA), which is difficult to implement when the coronary artery has severe diffuse lesions[11]. Ventricle-to-coronary vein bypass (VPASS) may be applied, this procedure decreases pressure of the coronary venous system to such an extent that the blood flow of retrograde perfusion is reduced, which may progress to inadequate perfusion[12]
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