Ventricle to Coronary Artery Bypass (VCAB™) - A New Minimally Invasive Technique for Myocardial Revascularisation

(#2001-6983 ... June 27, 2001)

Dieter H. Boehm¹ MD, PhD , Hermann Reichenspurner¹ MD, PhD, Bruno Reichart¹ MD, Franz Meisner² MD, Reinhard Wichels³ MD, Peter Boekstegers³ MD

¹Department of Cardiac Surgery, University Hospital Großhadern, Munich, Germany
² Institute of Surgical Research, University Hospital Großhadern, Munich, Germany
³Department of Internal Medicine I, University Hospital Großhadern, Munich, Germany

Presented at the Fourth Annual Scientific Meeting of the International Society for Minimally Invasive Cardiac Surgery, June 27-30, 2001, Munich, Germany.

ABSTRACT

Background: Left Ventricle-to-Coronary-Artery Bypass (VCAB™, Percardia, Merrimack, NH, 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: VCAB procedure was performed in a porcine animal model: 1. An L-shaped hollow tube was inserted through arteriotomy of the LAD (n=4) (rigid shunt) and 2. A stent-type device using a guide wire was inserted into the left ventricle through a puncture of the LAD (n=5) (VSTENTTM, Percardia, Merrimack, NH, USA). After creating a stable VCAB™ to the LAD, proximal occlusion of the LAD provided flow to the distal vessel exclusively through the VCAB™.

Results: In 4 pigs with a rigid shunt VCAB™ of similar diameter (2.5-3 mm) a consistent flow pattern was determined by an electromagnetic flow probe. Mean antegrade net-flow (Flsys-Fldiast) was 41% of baseline. Regional myocardial function assessed by sonomicrometry was 46% of baseline. Patency of VCAB™ was demonstrated up to 3h with unchanged preservation of blood flow and regional myocardial function. Despite complete occlusion of the proximal LAD artery, VSTENTTM provided net positive flow of 72% of baseline during systole, sufficient to maintain regional myocardial function at 85% of baseline in this pig model of acute regional ischemia.

Conclusions: The feasibility of two different approaches allowing a Ventricle-to- Coronary Artery Bypass VCAB™ was demonstrated.