Selective Retrograde Venous Revascularization of the Myocardium when PCI or CABG Is Impossible: Investigation in a Porcine Model
DOI:
https://doi.org/10.1532/HSF98.20071219Abstract
We investigated the possibility of nourishing the myocardium through selective retrograde coronary venous bypass grafting (CVBG) with an off-pump technique and evaluated various methods of monitoring the physiological effects of this procedure. In a porcine model, the left internal mammary artery (LIMA) was anastomosed to the left anterior descending coronary vein (LAD vein) in an off-pump procedure. The LAD vein was ligated proximal to the anastomosis. The LAD artery was ligated proximally. The physiological effects were monitored using microdialysis, tissue oxygen tension, blood flow in LIMA, blood samples, and hemodynamic and histological analyses. As controls, 5 pigs underwent surgery involving only LAD artery ligation without CVBG. CVBG with LAD ligation was performed in 16 pigs; 12 survived CVBG and were monitored for 2-2.5 hours while in sinus rhythm, a 75% salvage rate after an otherwise lethal LAD artery occlusion. Immediately after LAD artery ligation, the anterior wall of the left ventricle became cyanotic and hypokinetic. Over time it regained color and contractility as flow in the LIMA increased. Microdialysis showed a significant increase in lactate. Initially tissue oxygen tension decreased, but with time some recovery was seen. Cardiac troponin T was elevated. Histological analysis showed ischemic changes. In control pigs, microdialysis was performed for 1.5 hours up to LAD artery ligation, after which all pigs died in ventricular fibrillation arrest. No increase in lactate was observed. These results indicate that after LAD artery occlusion, CVBG can nourish the myocardium to a certain extent and prevent death in the majority of cases, although varying degrees of ischemia remain.References
Almeda FQ, Parrillo JE, Klein LW. 2003. Alternative therapeutic strategies for patients with severe end-stage coronary artery disease not amenable to conventional revascularization. Catheter Cardiovasc Interv 60:57-66.nBeck CS. 1948. Revascularization of the heart. Ann Surg 128(4):854-64.nBhayana JN, Olsen DB, Byrne JP, Kolff WJ. 1974. Reversal of myocardial ischemia by arterialization of the coronary vein. J Thorac Cardiovasc Surg 67(l):125-32.nGardner RS, Magovern GJ, Park SB, Dixon CM. 1974. Arterialization of coronary veins in the treatment of myocardial ischemia. J Thorac Cardiovasc Surg 68(2): 273-82.nHochberg MS, Roberts WC, Morrow AG, Austen WG. 1979. Selective arterialization of the coronary venous system: encouraging long-term flow evaluation utilizing radioactive microspheres. J Thorac Cardiovasc Surg 77(1):1-12.nHochberg MS, Roberts AJ, Parsonnet V, Fisch D. 1986. Selective arterialization of coronary veins: clinical experience of 55 American heart surgeons. In: Mohl W, Faxon DP Wolner E, editors. Clinics of CSI. New York: Springer-Verlag; p. 195-201.nKulik A, Borger MA, Scully HE. 2004. Aortovenous bypass grafting to the posterior left ventricle in absence of an identifiable coronary artery. Ann Thorac Surg 78:313-4.nMantovani V, Kennergren C, Goiny M, et al. 2006. Microdialysis for myocardial metabolic surveillance: developing a clinical technique. Clin Physiol Funct Imaging 26:224-231.nMukherjee D, Bhatt DL, Roe MT, Patel V, Ellis SG. 1999. Direct myocardial revascularization and angiogenesis: how many patients might be eligible? Am J Cardiol 84:598-600.nPratt FH. 1898. The nutrition of the heart through the vessels of thebesius and the coronary veins. Am J Physiol 1:86-103.nSadaba JR, Nair UR. 2004. Selective arterialization of the coronary venous system. Ann Thorac Surg 78:1458-60.nWikström G, Ronquist G, Nilsson S, Maripu E, Waldenström A. 1995. Continuous monitoring of energy metabolites using microdialysis during myocardial ischaemia in the pig. Eur Heart J 16:339-47.n
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