All Title Author
Keywords Abstract

PLOS ONE  2013 

Outcomes of Middle Cardiac Vein Arterialization via Internal Mammary/Thoracic Artery Anastomosis

DOI: 10.1371/journal.pone.0080963

Full-Text   Cite this paper   Add to My Lib


Objective Cardiac 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. Methods A 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. Results The 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. Conclusion Successful 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.


[1]  Yamane M (2012) Current percutaneous recanilization of coronary chronic total occlusion. Rev Esp Cardiol 65: 265–277.
[2]  Ielasi A, Latib A, Chieffo A, Takagi K, Mussardo M, et al. (2012) Very long-term outcomes following drug-eluting stent implantation for unprotected left main coronary artery stenosis: A single center experience. Rev Esp Cardiol DOI pii:S0300-8932(12)00455-1. (Epub ahead of print)
[3]  Gardner RS, Magovern GJ, Park SB, Dixon CM (1974) Arterialization of coronary veins in the treatment of myocardial ischemia. J Thorac Cardiovasc Surg 68: 273–282.
[4]  Okada M, Shimizu K, Ikuta H, Horii H, Nakamura K (1991) A new method of myocardial revascularization by laser. Thorac Cardiovasc Surg 39: 1.
[5]  Isner JM (2002) Myocardial gene therapy. Nature 415: 234–239.
[6]  Sundt TM 3rd, Camillo CJ, Mendeloff EN, Barner HB, Gay WA Jr (1999) Reappraisal of coronary endarterectomy for the treatment of diffuse coronary artery disease. Ann Thorac Surg 68: 1272–1277.
[7]  Briones E, Lacalle JR, Marin I (2011) Transmyocardial laser revascularization versus medical therapy for refractory angina. Sao Paulo Med J 129: 186–186.
[8]  Stewart DJ, Kutryk MJ, Fitchett D, Freeman M, Camack N, et al. (2009) NORTHERN Trial Investigators.VEGF gene therapy fails to improve perfusion of ischemic myocardium in patients with advanced coronary disease: Results of the NORTHERN Trial. Mol Ther 17: 1109–1115.
[9]  Gali?anes M (2005) New prospects in myocardial surgical revascularization. Rev Esp Cardiol 58: 1459–1468.
[10]  Marco JD, Hahn JW, Barner HB, Jellinek M, et al. (1977) Coronary venous arterialization: acute hemodynamic, metabolic, and chronic anatomical observations. Ann Thorac Surg 23: 449–454.
[11]  Kassab GS, Navia JA, March K, Choy JS (2008) Coronary venous retroperfusion: an old concept, a new approach. J Appl Physiol 104: 1266–1272.
[12]  Raake P, Hinkel R, Kupatt C, von Brühl ML, Beller S, et al. (2005) Percutaneous approach to a stent-based ventricle to coronary vein bypass (venous VPASS?): comparison to catheter-based selective pressure-regulated retro-infusion of the coronary vein. Eur Heart J 26: 1228–1234.
[13]  Arealis EG, Volder JG, Kolff WJ (1973) Arterialization of the coronary vein coming from an ischemic area. Chest 63: 462–463.
[14]  Bhayana JN, Olsen DB, Byrne JP, Kolff WJ (1974) Reversal of myocardial ischemia by arterialization of the coronary vein. J Thorac Cardiovasc Surg 67: 125–132.
[15]  Hochberg 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: 1–2.
[16]  Hochberg MS, Roberts AJ, Parsonnet V, Fisch D (2002) 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; pp. 195–201.
[17]  M?eller CH, N?rgard MA, G?tze JP, Anderson CB, Olsen NV, et al. (2008) Selective retrograde venous revascularization of the myocardium when PCI or CABG is impossible: Investigation in a porcine model. The Heart Surgery Forum (#2007) 11: E99.104.
[18]  Sadaba JR, Nair UR (2004) Selective arterialization of the coronary venous system. Ann Thorac Surg 78: 1458–1460.
[19]  Fitzgerald PJ, Hayase M, Yeung AC, Virmani R, Robbins RC, et al. (1999) New approaches and conduits: In situ venous arterialization and coronary artery bypass. Curr Interv Cardiol Rep 1: 127–137.
[20]  Hochberg MS, Austen WG (1980) Selective retrograde coronary venous perfusion. Ann Thorac Surg 29: 578–588.
[21]  Harig F, Schmidt J, Hoyer E, Eckl S, Adamek E, et al. (2011) Long-term evaluation of a selective retrograde coronary venous perfusion model in pigs (Sus scrofa domestica). Comp Med 61: 150–157.
[22]  Ido A, Hasebe N, Matsuhashi H, Kikuchi K (2001) Coronary sinus occlusion enhances coronary collateral flow and reduces subendocardial ischemia. Am J Physiol Heart Circ Physiol 280: H1361–H1367.
[23]  Resetar ME, Ullmann C, Broeske P, Ludwig-Schindler K, Doll NK, et al. (2007) Selective arterialization of a cardiac vein in a model of cardiac microangiopathy and macroangiopathy in sheep. J Thorac Cardiovasc Surg 133: 1252–1256.
[24]  Yu Y, Yan XL, Wei H, Yang JF, Gu CX (2011) Off-pump sequential bilateral internal mammary artery grafting combined with selective arterialization of the coronary venous system. Chin Med J (English) 124: 3017–3021.
[25]  Chowdhry MF, Davies J, McCance A, Gali?anes M (2005) Lack of durability of surgical arterialization of coronary veins for the treatment of ischemic heart disease. J Card Surg 20: 326–328.
[26]  Piljs NH, Sels JW (2012) Functional measurement of coronary stenosis. J Am Coll Cardiol 59: 1045–1057.
[27]  Trana C, Muller O, Eeckhout E (2011) Coronary artery disease diagnostic with fractional flow reserve. Rev Med Suisse 7: 1182–1188.
[28]  Beller GA, Heede RC (2011) SPECT imaging for detecting coronary artery disease and determining prognosis by noninvasive assessment of myocardial perfusion and myocardial viability. J Cardiovasc Transl Res 4: 416–424.


comments powered by Disqus