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Bypass Without the Surgeon: The Coronary Veins as Arterial Conduits
1Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, 200 First Street, SW, Rochester, MN 55905, USA. holmes.david@mayo.edu
Insights
Coronary venous retroperfusion can maintain heart muscle viability during ischemia. Novel percutaneous strategies are being developed to use coronary veins for myocardial revascularization when arterial bypass is not possible.
Area of Science:
- Cardiovascular Science
- Ischemic Heart Disease Research
- Vascular Biology
Background:
- Pratt's early work showed arterial blood perfusion of coronary veins sustains myocardium during ischemia.
- Atherosclerosis's sparing of coronary veins and their parallel course to arteries spurred interest in venous retroperfusion.
- While older venous retroperfusion methods are largely obsolete, coronary veins remain a viable therapeutic target.
Purpose of the Study:
- To explore novel percutaneous strategies for myocardial revascularization using coronary veins.
- To evaluate the potential of coronary venous pathways when direct arterial revascularization is not feasible.
Main Methods:
- Review of historical and current approaches to coronary venous retroperfusion.
- Animal studies evaluating novel percutaneous strategies for venous myocardial revascularization.
Main Results:
- Historical venous retroperfusion techniques have been largely superseded.
- Novel percutaneous strategies targeting coronary veins for myocardial revascularization have shown promise in animal models.
Conclusions:
- Coronary veins represent a potential therapeutic target for myocardial revascularization.
- Percutaneous approaches targeting coronary veins offer a promising alternative when arterial revascularization is challenging.
Abstract:
More than a century ago, Pratt demonstrated that perfusion of arterial blood through the coronary veins could sustain myocardial viability during acute ischemia. Recognition that atherosclerosis spared the coronary veins and that these vessels frequently followed a parallel course to the corresponding artery provided the necessary stimulus for the development and evaluation of several methods of venous retroperfusion. Although most of these procedures have now been superseded, the coronary veins remain a tempting therapeutic target when direct arterial revascularization is not feasible. Novel percutaneous strategies using these vessels to provide definitive myocardial revascularization have been proposed and extensively tested in animals.
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