ABSTRACT 21

VENTRICLE-TO-CORONARY ARTERY BYPASS (VCAB^TM) – A NEW TECHNIQUE FOR MYOCARDIAL REVASCULARISATION

¹Hermann Reichenspurner, ¹Dieter H. Boehm, ²Reinhard Wichels, ³Franz Meisner, ¹Bruno Reichart, ²Peter Boekstegers

¹Dpt. of Cardiac Surgery, University Hospital Grosshadern, Germany
²Internal Medicine I, University Hospital Grosshadern, Germany
³Institute for Surgical Research, Munich, Germany

Left Ventricle-to-Coronary-Artery Bypass (VCAB^TM, Percardia, USA) might be an alternative approach for myocardial revascularisation in patients without conventional treatment options. In order to provide direct blood flow from the left ventricle to the coronary artery we tested two different approaches in this study:

Materials and Methods:1. an L-shaped hollow tube was inserted after arteriotomy of the LAD (n=4) and 2. a stent-type device using a guide wire was inserted into the left ventricle through a puncture of the LAD (n=2).  After creating a stable VCAB^TM to the LAD, proximal occlusion of the LAD provided flow to the distal vessel exclusively through the VCAB^TM.

Results: In 6 pigs with VCAB^TM of similar diameter (2,5-3 mm) a consistent flow pattern determined by an electromagnetic flow (Fl_diast) during diastole. Mean antegrade net-flow (Fl_sys-Fl_diast) was 77% of baseline. Regional myocardial function assessed by sonomicrometry was 78% of baseline (table). Patency of VCAB^TM was demonstrated up to 3h with unchanged preservation of blood flow and regional myocardial function.

Conclusions: The feasibility of two different approaches to Ventricle-to-Coronary Artery Bypass VCAB^TM was demonstrated. Despite complete occlusion of the proximal LAD artery, VCAB^TM provided net positive flow during systole, sufficient to maintain regional myocardial function at 78% of baseline in this pig model of acute regional ischemia.