Hemodynamic and vascular effects of ventricular sourcing by stent-based ventricle to coronary Artery bypass in patients with multivessel disease undergoing coronary artery bypass surgery

• Published in: Circulation (New York, N.Y.) N.Y.), 2005-08, Vol.112 (9), p.I304-I310
• Main Authors: BOEKSTEGERS, Peter, RAAKE, Philip, VICOL, Calin, HINKEL, Rabea, POHL, Tilmann, KUPATT, Christian, KNEZ, Andreas, CHRIST, Frank, EIFERT, Sandra, STEINBECK, Gerhard, REICHART, Bruno
• Format: Article
• Language: English
• Subjects: Aged; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Coronary Angiography; Coronary Artery Bypass - methods; Coronary Circulation; Coronary heart disease; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Echocardiography, Stress; Female; Follow-Up Studies; Graft Occlusion, Vascular - epidemiology; Heart; Heart Ventricles - surgery; Hemodynamics; Humans; Male; Medical sciences; Middle Aged; Stents; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Treatment Outcome
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/CIRCULATIONAHA.104.524751

The hemodynamic and vascular effects of ventricular sourcing by a stent-based (VSTENT, Percardia) left ventricle-to-coronary artery bypass were studied in a patient subgroup of the European multicenter ADVANTAGE study (ADjunctive treatment with the VCAB/VSTENT myocardial implANT system in coronary Artery bypass Graft patiEnts). Twelve patients who underwent VSTENT implantation in addition to coronary artery bypass surgery were studied up to 12 months after the procedure. The VSTENT was implanted distal to a hemodynamically relevant coronary artery stenosis. Coronary flow velocity was assessed at rest and during dobutamine stress. Intraoperative VSTENT implantation was successful in 11 of 12 patients. Early postoperative angiograms showed patent VSTENT in 8 of 11 patients, with predominantly systolic flow distal to the VSTENT. Coronary flow velocity reserve induced by dobutamine stress was 1.7+/-0.1 (P=0.006). VSTENT patency at 2- to 6-month follow-up was present in 5 of 11 patients, with concomitant VSTENT stenosis in 4 of those 5. In all patients, coronary flow velocity increased 3- to 4-fold proximal to the VSTENT, which was associated with a moderate degree of arterial remodeling. Except for target vessel reintervention (n=5), no other major adverse events were observed in 11 of 12 patients. One patient died on the second postoperative day, though the cause was probably not related to the VSTENT implantation. VSTENT implantation seems to be safe in the mid-term follow-up and leads to a predominantly systolic coronary flow pattern in the vessel supplied by the VSTENT, with a flow reserve similar or close to that seen with conventional bypass. VSTENT patency rate, however, was unacceptably low at 3- to 6-month follow-up and needs to be improved.