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J Thorac Cardiovasc Surg 2007;133:1252-1256
© 2007 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Selective arterialization of a cardiac vein in a model of cardiac microangiopathy and macroangiopathy in sheep

Michaela Elisabeth Resetar, MDa,*, Cris Ullmanna, Petra Broeskea, Kristin Ludwig-Schindlera, Nicolas K. Doll, MD, PhDa, Aida Salameh, MDb, Stefan Dhein, MD, PhDa, Friedrich W. Mohr, MD, PhDa

a Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany.
b Department of Cardiology, Heart Center, University of Leipzig, Leipzig, Germany.

Received for publication January 23, 2006; revisions received December 11, 2006; accepted for publication December 14, 2006.

* Address for reprints: Michaela Elisabeth Resetar, MD, University of Leipzig, Heart Center Strümpelstrasse 39, 04289 Leipzig, Germany. (Email: michaela.resetar{at}med.uni-leipzig.de).

Objective: Some patients with significant arteriosclerosis of the heart are not amenable to revascularization of a coronary artery because they have a combination of microangiopathy and significant macroangiopathy. We investigated the benefit of arterialization of a cardiac vein under these circumstances in an acute animal model.

Methods: In the hearts of 8 sheep, microspheres were injected into the left coronary artery; 60 minutes later, a stenosis of the left anterior descending artery was performed. After 45 minutes, retrograde venous revascularization was performed by sewing the left internal thoracic artery to the concomitant vein of the left anterior descending artery in a beating-heart technique. For flow reversal, the vein was ligated proximally to the anastomosis. The efficiency of the bypass graft was evaluated by coronary angiography and flow measurement. Cardiac output, electrocardiography, and mean arterial blood pressure were assessed in each phase of the experiment.

Results: The ischemic state of the myocardium was confirmed by a significant decrease of cardiac output, stroke volume, and mean arterial blood pressure, and a significant elevation of the ST segment in the electrocardiography. After retrograde venous revascularization was established, cardiac output and stroke volume increased and ST elevations decreased. The grafts showed adequate flow (26.15 ± 2.08 mL/min), and reversed blood flow in the grafted vein was proved by coronary angiography.

Conclusion: Retrograde venous revascularization is possible and improves cardiac function in a state of acute ischemia caused by a combination of microangiopathy and macroangiopathy.

Abbreviations and Acronyms ECG = electrocardiogram; LAD = left anterior descending; LCA = left coronary artery






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