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DOI: 10.1055/s-0029-1191686
Selective arterialization of V.cordis magna (retrobypass) prevents hemodynamic instability after LAD-occlusion in a porcine long term model
Objectives: The lack of eligible target vessels remains a challenge for aortocoronary bypass grafting in end stage coronary heart disease. Since the coronary sinus is a standardized access for retrograde cardioplegia, the arterialization of venous vessels is in the focus of research for alternative myocardial revascularisation strategies. Therefore the technical feasibility of this technique was investigated in a porcine long term model.
Methods: After anaesthesia, hemodynamic monitoring and median sternotomy of 16 landrace pigs, an aorta-to-coronary-vein (V. cordis magna, VCM) bypass (Retrobypass) was performed. Acute infarction was simulated by LAD ligation. In group A (n=12), LAD was ligated, a venous bypass performed and the VCM was proximally ligated. In group B (n=4), same procedure was performed without VCM ligation. Intraoperative angiograms, hemodynamic performance (Cardiac output, CO and stroke volume, SV) and survival time were analyzed.
Results: Hemodynamic performance in group A was significantly better than in group B (CO, 7.0ml/min vs. 3.2, p<.05; SV, 48ml vs. 29, p<.05). An open bypass could be verified angiographically in all animals. Distal flow could only be established by proximal ligation of VCM. In group B, there was no long term survival after 4h. In group A, long term survival was 83% (10/12 animals) with a cumulative survival of 891 days, mean 99d.
Conclusions: Retrobypass is an effective technique to achieve long term survival after acute LAD occlusion in a pig model. Proximal ligation of V. cordis magna is mandatory. Additional experiments will focus on structural and functional investigations.