Catheter-based ventricle-coronary vein bypass.

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Biomedical Engineering

Background:

• Coronary artery disease (CAD) remains a leading cause of mortality, with limited options for end-stage patients.
• Percutaneous coronary venous arterialization is an emerging strategy for treating refractory CAD.
• Myocardial perfusion is critical for heart function and viability.

Purpose of the Study:

• To evaluate the feasibility of a catheter-based ventricle-to-coronary vein bypass (VPASS) procedure.
• To assess the efficacy of a VSTENT implant for retrograde myocardial perfusion.
• To investigate VPASS as a potential treatment for end-stage myocardial ischemia.

Main Methods:

• Acute swine model to assess VPASS procedure and VSTENT implant deployment.
• Measurement of coronary venous flow and pressure patterns.
• Chronic pilot study with VPASS in animals with LAD occlusion/stenosis.
• Left ventriculography and MRI for patency and myocardial viability assessment at 30 days.

Main Results:

• VPASS procedure and VSTENT implant deployment were successful without complications.
• Equalization of left ventricular (LV) and anterior interventricular vein (AIV) systolic pressures was achieved.
• Retrograde flow in the distal AIV was established (maximal flow velocity: 37 ± 7 cm/sec).
• VSTENT implant patency and myocardial viability were confirmed at 30 days, even with LAD occlusion.

Conclusions:

• Catheter-based VPASS is a feasible technique for retrograde myocardial perfusion.
• The VSTENT implant facilitates coronary retrograde perfusion.
• VPASS may offer a novel therapeutic approach for patients with end-stage myocardial ischemia.