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J Thorac Cardiovasc Surg 2008;135:769-770
© 2008 The American Association for Thoracic Surgery

Invited Commentary

Discussion

Dr Todd K. Rosengart (Stony Brook, NY). The authors are to be congratulated for translating solid experimental laboratory data into a logical extension in clinical Unfortunately, as has been the case on a number of occasions, the human condition has confounded the efforts to reasonably and logically test some of your experimental hypotheses. I have a number of questions; but I'll ask you 4, which I'll ask you one at a time for simplicity.

First, why did you not administer VEGF into an unrevascularized territory so you could take advantage of a low baseline perfusion level as opposed to administering VEGF into the LAD territory? Obviously, this creates potential problems of artifact because of your bypass grafts.

Dr Ruel. This is an excellent question and a point that we had to resolve at the design level of the study. VEGF is a relatively poor angiogenic factor, but it is intimately NO dependent, perhaps more than fibroblast growth factor-2 and hepatocyte growth factor, which are other cytokines that are potentially more robust. We also chose VEGF first because it has been widely studied in humans, and part of this comes from your work as well. We also chose VEGF because . . . [Full Text of this Article]