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European Heart Journal Advance Access published online on February 25, 2005
European Heart Journal, doi:10.1093/eurheartj/ehi136
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European Heart Journal © The European Society of Cardiology 2005; all rights reserved

Preclinical research

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 Raake 1, Rabea Hinkel 1, Christian Kupatt 1, Marie-Luise von Brühl 1, Sabrina Beller 1, Martin Andrees 1, Calin Vicol 2, and Peter Boekstegers 1*

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

* To whom correspondence should be addressed.
Peter Boekstegers, E-mail: boekstegers{at}med1.med.uni-muenchen.de


  Abstract

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.

Keywords: Myocardial ischaemia; Revascularization; Ventricular sourcing; Ventricle to coronary vein bypass; Retro-infusion.
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[Abstract] [Full Text] [PDF]


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