Related Experiment Video
Updated: May 14, 2026
Surgical Porcine Model of Chronic Myocardial Ischemia Treated by Exosome-laden Collagen Patch and Off-pump Coronary Artery Bypass Graft
Published on: September 15, 2023
Comparative analysis of bypass vs. stent for coronary revascularization using an ex-vivo organ care system in an
Philipp Lindenhahn1,2,3, Rabea Hinkel4,5,6, L Christian Napp7
1Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany. philipp.lindenhahn@tiho-hannover.de.
Insights
Coronary artery bypass grafting (CABG) improved lymphatic flow and myocardial perfusion compared to percutaneous coronary intervention (PCI) in a swine model. CABG resulted in smaller infarct areas and better heart function post-intervention.
Area of Science:
- Cardiovascular Research
- Interventional Cardiology
- Surgical Cardiology
Background:
- Patients with coronary artery disease often choose between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG).
- Long-term biological effects of PCI versus CABG on coronary artery anatomy and physiology remain largely unknown.
- A novel artificial atherosclerotic plaque (AAP) model in porcine hearts was developed to simulate coronary atherosclerosis.
Purpose of the Study:
- To investigate and compare the physiological changes induced by PCI and CABG in vascular and perivascular tissues.
- To evaluate the long-term effects of PCI and CABG on lymphatic flow and myocardial perfusion.
- To assess the impact of PCI and CABG on myocardial infarct size and function.
Main Methods:
- An artificial atherosclerotic plaque (AAP) was implanted into the left anterior descending coronary artery (LAD) of eight German landrace swine.
- Ex vivo assessment of physiological changes using an organ care system (OCS).
- Radiological and nuclear imaging techniques including single photon emission computed tomography (SPECT) and computed tomography (CT) were employed.
Main Results:
- Coronary artery bypass grafting (CABG) demonstrated improved lymphatic flow and myocardial perfusion compared to percutaneous coronary intervention (PCI).
- The PCI group exhibited a significantly higher mean count number proximal to the intervention site in the LAD.
- CABG-treated hearts showed smaller myocardial infarct areas and better myocardial function post-intervention in the OCS setting.
Conclusions:
- The artificial atherosclerotic plaque model in porcine hearts is a valuable tool for simulating coronary artery stenosis.
- Data suggest that cardiac lymphatic vascular system and perfusion capability are partly restricted after PCI compared to CABG.
- Further research using this model can elucidate specific aspects of coronary artery physiology and treatment outcomes.
Abstract:
Many patients with coronary artery disease are eligible for either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Technical and clinical aspects influence the decision for either treatment. However, biological effects of PCI and CABG on long-term coronary artery anatomy and physiology should be considered but are largely unknown. Eight German landrace swine were used in this study. An artificial atherosclerotic plaque (AAP) was implanted into the left anterior descending coronary artery (LAD) to simulate coronary atherosclerosis. Physiological changes of PCI and surgical CABG in vascular and perivascular tissue were assessed in an ex vivo setting (organ care system OCS). Furthermore, radiological and nuclear imaging was performed using single photon emission computed tomography (SPECT) and computed tomography (CT). Furthermore, interventional (PCI) and surgical (CABG) treatment was evaluated using an ex-vivo setting. Lymphatic flow and myocardial perfusion were improved in pigs in the CABG group compared to the PCI group. The PCI group showed a significantly higher mean count number proximal to the intervention in the LAD area. Stenting experiments showed a significantly higher mean count number proximal to the intervention in the LAD area. This effect could also be demonstrated macroscopically, as myocardial infarct areas were smaller and myocardial function was better after defibrillation in the OCS (organ care system) in the CABG treated hearts. The artificial atherosclerotic plaque model in porcine hearts is a new valuable tool to simulate coronary artery stenosis without damaging other organs. It may serve as a tool for future medical testing and for further specific research on coronary artery physiology. Our data suggest that the cardiac lymphatic vascular system and perfusion capability are partly restricted after PCI as compared to CABG.
