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European Heart Journal Advance Access originally published online on February 25, 2005
European Heart Journal 2005 26(12):1228-1234; doi:10.1093/eurheartj/ehi136
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© The European Society of Cardiology 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oupjournals.org

Percutaneous approach to a stent-based ventricle to coronary vein bypass (venous VPASSTM): comparison to catheter-based selective pressure-regulated retro-infusion of the coronary vein

Philip Raake1, Rabea Hinkel1, Christian Kupatt1, Marie-Luise von Brühl1, Sabrina Beller1, Martin Andrees1, Calin Vicol2 and Peter Boekstegers1,*

1Department of Internal Medicine I, Grosshadern University Hospital, Marchioninistr. 15, D-81377 Munich, Germany
2Department of Cardiac Surgery, Grosshadern University Hospital, Marchioninistr. 15, D-81377 Munich, Germany

Received 19 August 2004; revised 17 December 2004; accepted 23 December 2004; online publish-ahead-of-print 25 February 2005.

* Corresponding author. Tel: +49 89 7095 3051; fax: + 49 89 7095 3064. E-mail address: boekstegers{at}med1.med.uni-muenchen.de

Aims Percutaneous stent-based ventricle-to-coronary vein bypass (venous VPASSTM) is a new approach to chronic venous arterialization as a treatment modality in an otherwise no option patient with coronary artery disease. In this study, the efficacy of venous VPASSTM was compared with catheter-based selective pressure-regulated retro-infusion of arterial blood during acute ischaemia.

Methods and results In seven pigs, venous VPASSTM was established using a percutaneous ultrasound-guided puncture from the anterior cardiac vein to the left ventricle, with subsequent implantation of an ePTFE-covered stent graft. During left anterior descending artery (LAD) occlusion, coronary venous pressure in the distal anterior cardiac vein increased to 55±4 mmHg under conditions of venous VPASSTM compared with 78±5 mmHg during selective pressure-regulated retro-infusion. Significant preservation of regional myocardial function was observed during venous VPASSTM (67±6% baseline) and during selective retro-infusion (83±4%) compared with control LAD occlusion (0.4±2%).

Conclusion Percutaneous implantation of a PTFE covered stent (venous VPASSTM) was feasible and associated with significant preservation of regional myocardial function during acute ischaemia in pigs at reasonable levels of mean coronary venous pressure to avoid tissue damage during chronic application.

Key Words: Myocardial ischaemia • Revascularization • Ventricular sourcing • Ventricle to coronary vein bypass • Retro-infusion


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