Direct Left Ventricle to Great Cardiac Vein Retroperfusion: A Novel Alternative to Myocardial Revascularization

Authors

  • Geng-Hua Yi
  • Kun-Lun He
  • Nicholas C. Dang
  • Myung Jae Lee
  • Patrick Cahalan
  • Aftab R. Kherani
  • An Gu
  • Daniel Burkhoff
  • Jie Wang

DOI:

https://doi.org/10.1532/HSF98.20051104

Abstract

Background. As the number of patients with diffuse coronary artery disease continues to grow, there is renewed interest in alternative methods of perfusing the ischemic myocardium. We tested the feasibility of myocardial retroperfusion via a direct left ventricle-to-great cardiac vein (LV-GCV) conduit to support regional contractility in this setting.

Methods. LV-GCV flow was established using an extracorporeal circuit in 5 dogs. Left ventricle (LV) pressure, aortic pressure, regional myocardial segment length, and circuit blood flow were measured prior to left anterior descending coronary artery (LAD) ligation, following LAD ligation, and after LV-GCV circuit placement. To eliminate backward flow during diastole, an in-line flow regulator was placed. Regional myocardial function was quantified by pressure-segment length loop area divided by end-diastolic segment length (PSLA/EDSL).

Results. LAD ligation reduced PSLA/EDSL from 10.0 ± 1.2 mm Hg ´ mm to 1.6 ± 0.3 mm Hg ´ mm (P < .05). With LV-GCV retroperfusion, mean peak systolic flow was +152 ± 14 mL/min, mean peak diastolic flow was -39 ± 11 mL/min, and net mean flow was +36 ± 13 mL/min. Regional function recovered to ~39% of baseline (3.9 ± 0.4 mm Hg ´ mm, P < .05). Upon elimination of backflow, mean flow increased to +41 ± 12 mL/min and regional function recovered even further to ~47% of baseline (4.6 ± 0.7 mm Hg ´ mm, P < .05). Conclusions. A LV-GCV circuit can significantly restore regional function to the acutely ischemic myocardium. An inline valve that eliminates backward diastolic flow improves regional function even further. This approach may provide an effective therapy for diffuse coronary disease not amenable to traditional revascularization strategies.

References

Kar S, Drury JK, Hajduczki I, et al. 1991. Synchronized coronary venous retroperfusion for support and salvage of ischemic myocardium during elective and failed angioplasty. J Am Coll Cardiol 18:271-82.nFarcot JC, Berdeaux A, Giudicelli JF, Vilaine JP, Bourdarias JP. 1983. Diastolic synchronized retroperfusion versus reperfusion: effects on regional left ventricular function and myocardial blood flow during acute >coronary occlusion in dogs. Am J Cardiol 51:1414-21.nLazar HL, Treanor P, Rivers S, Bernard S, Shemin RJ. 1995. Combining percutaneous bypass with coronary retroperfusion limits myocardial necrosis. Ann Thorac Surg 59:373-8.nMartin JS, Byrne JG, Ghez OY, et al. 2000. LV-powered coronary sinus retroperfusion reduces infarct size in acutely ischemic pigs. Ann Thorac Surg 69:84-9.nMeerbaum S. 1986. Coronary venous retroperfusion delivery of treatment to ischemic myocardium. Herz 11:41-54.nO'Byrne GT, Nienaber CA, Miyazaki A, et al. 1991. Positron emission tomography demonstrates that coronary sinus retroperfusion can restore regional myocardial perfusion and preserve metabolism. J Am Coll Cardiol 18:257-70.nOesterle SN, Reifart N, Hauptmann E, Hayase M, Yeung AC. 2001. Percutaneous in situ coronary venous arterialization: report of the first human catheter-based coronary artery bypass. Circulation 103:2539-43.nSuehiro K, Shimizu J, Yi GH, et al. 2001. Direct coronary artery perfusion from the left ventricle [published correction appears in J Thorac Cardiovasc Surg 2001;121:1063]. J Thorac Cardiovasc Surg 121:307-15.nKowallik P, Schulz R, Guth BD, et al. 1991. Measurement of regional myocardial blood flow with multiple colored microspheres. Circulation 83:974-82.nGerber TC, Kantor B, Keelan PC, Hayes DL, Schwartz RS, Holmes DR. 2000. The coronary venous system: an alternate portal to thenmyocardium for diagnostic and therapeutic procedures in invasive cardiology. Curr Interv Cardiol Rep 2:27-37.nKeelan PC, Kantor B, Gerber TC, Holmes DR, Schwartz RS. 2000. Bypass without the surgeon: the coronary veins as arterial conduits. Curr Interv Cardiol Rep 2:11-9.nBerdeaux A, Farcot JC, Bourdarias JP, Barry M, Bardet J, Giudicelli JF. 1981. Effects of diastolic synchronized retroperfusion on regional coronary blood flow in experimental myocardial ischemia. Am J Cardiol 47:1033-40.nChang BL, Drury JK, Meerbaum S, Fishbein MC, Whiting JS, Corday E. 1987. Enhanced myocardial washout and retrograde blood delivery with synchronized retroperfusion during acute myocardial ischemia. J Am Coll Cardiol 9:1091-8.nCostantini C, Sampaolesi A, Serra CM, et al. 1991. Coronary venous retroperfusion support during high risk angioplasty in patients with unstable angina: preliminary experience. J Am Coll Cardiol 18:283-92.n

Published

2006-01-31

How to Cite

Yi, G.-H., He, K.-L., Dang, N. C., Lee, M. J., Cahalan, P., Kherani, A. R., Gu, A., Burkhoff, D., & Wang, J. (2006). Direct Left Ventricle to Great Cardiac Vein Retroperfusion: A Novel Alternative to Myocardial Revascularization. The Heart Surgery Forum, 9(2), E579-E586. https://doi.org/10.1532/HSF98.20051104

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