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Published on: July 25, 2022
Percutaneous in situ coronary venous arterialization: a catheter-based procedure for coronary artery bypass
1The University of Frankfurt, Chief Department of Cardiology, Main Taunus Hospitals, Bad Soden, Germany. n.reifart@reifart-partner.de
Insights
Percutaneous in situ coronary venous arterialization (PICVA) offers a novel approach for treating diffuse coronary artery disease. This catheter-based bypass shows promise for patients ineligible for traditional treatments, despite early safety trial challenges.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Regenerative Medicine
Background:
- Diffuse coronary artery disease often precludes traditional revascularization methods like bypass surgery or angioplasty.
- Surgical arterialization of the coronary venous system has been a historical option for 'no-option' patients.
- Percutaneous techniques aim to replicate surgical benefits minimally invasively.
Purpose of the Study:
- To evaluate the feasibility and safety of percutaneous in situ coronary venous arterialization (PICVA) in humans.
- To assess the potential of PICVA as a catheter-based alternative for diffuse coronary artery disease.
- To explore the retroperfusion of ischemic myocardium via coronary vein arterialization.
Main Methods:
- Utilized unique catheter-based devices for percutaneous coronary venous arterialization.
- Applied the technique in a series of 11 highly symptomatic "no-option" patients.
- Conducted the PICVA European Safety trial to assess initial human applications.
Main Results:
- Demonstrated the feasibility of catheter-based coronary bypass in "no-option" patients.
- Observed reduction in ischemia and myocardial damage in preclinical animal models.
- Encountered two deaths and six bypass failures in the initial human safety trial.
Conclusions:
- PICVA shows potential as a novel interventional treatment for diffuse coronary artery disease.
- Further development is needed to overcome technical challenges and improve safety outcomes.
- Catheter-based coronary bypass may become a viable option for previously untreatable patients with further refinement.
Abstract:
Diffuse coronary artery disease is frequently untreatable by coronary artery bypass or angioplasty. Open chest surgical arterialization of the coronary venous system was successfully performed before the widespread use of coronary artery bypass grafting and has been applied in ungraftable patients thereafter. Percutaneous in situ coronary venous arterialization (PICVA) follows this surgical experience, using a series of unique catheter-based devices to arterialize isolated segments of coronary vein, forcing retroperfusion of severely ischemic myocardium. In a series of animals, this procedure had been shown to reduce ischemia and myocardial damage in an infarction model. In the PICVA European Safety trial, the first 11 percutaneous applications of catheter-based coronary bypass in humans revealed feasibility of the technique in highly symptomatic "no-option" patients. Despite two deaths and six failures to create the bypass, we continue to believe that on further development, the catheter-based coronary bypass can become a broad-based interventional application.
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