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J Thorac Cardiovasc Surg 2004;127:1751-1758
© 2004 The American Association for Thoracic Surgery

Cardiopulmonary support and physiology

Myocardial blood supply through a direct left ventricle–coronary artery shunt is not aided by augmented coronary capacitance

^a Experimental Cardiology Laboratory, University Medical Center Utrecht, Utrecht, The Netherlands

Received for publication May 9, 2003; revisions received August 8, 2003; accepted for publication September 29, 2003.

^* Address for reprints: Paul F. Gründeman, MD, PhD, Experimental Cardiology Laboratory, University Medical Center Utrecht, Heidelberglaan 100, Room G02.523, 3584 CX Utrecht, The Netherlands
P.F.Grundeman{at}hli.azu.nl

OBJECTIVES: Left ventricle–coronary artery shunting is proposed as an alternative means of myocardial revascularization when standard methods are not an option. During diastole, however, regurgitant coronary flow to the left ventricle decreases the efficacy of the left ventricle–coronary artery shunt. We investigated whether augmented coronary compliance would improve net forward shunt flow.

METHODS: In 11 anesthetized pigs a specially designed stent was placed through the lateral wall of the left ventricle. Through an arterial graft, it was connected to the proximal left anterior descending coronary artery. A blind stump of the right internal thoracic artery (15 cm) was anastomosed to the distal left anterior descending coronary artery to serve as added coronary compliance chamber. Blood flow was measured in the coronary artery just distal from the left ventricle–coronary artery shunt, as well as in the shunt and in the compliance chamber entrance-exit.

RESULTS: The left ventricle–coronary artery shunt decreased the net forward midcoronary flow to 53% ± 18% (mean ± SD) of native flow (8 ± 4 vs 16 ± 5 mL/min at baseline, P < .01). The augmented compliance did not significantly increase net forward coronary flow (61% ± 25% of native flow, P < .01 vs baseline and P = .21 vs left ventricle–coronary artery shunt with normal compliance). The increase in systolic forward flow (53 ± 23 vs 37 ± 19 mL/min with normal compliance) was accompanied by a similar increase in diastolic regurgitant flow (–26 ± 20 vs –16 ± 16 mL/min).

CONCLUSION: In healthy pigs a left ventricle–coronary artery shunt decreased net forward coronary flow to 53% ± 18% of native flow. Augmentation of coronary artery compliance did not improve shunt performance.

This article has been cited by other articles:

				S. de Zeeuw, C. Borst, C. W.J. Verlaan, and P. F. Grundeman Transmural Differences in Myocardial Function and Metabolism During Direct Left Ventricular to Coronary Artery Sourcing Ann. Thorac. Surg., July 1, 2005; 80(1): 153 - 161. [Abstract] [Full Text] [PDF]