Ventriculocoronary artery bypass (VCAB), a novel approach to myocardial revascularization.

BACKGROUND: The long-term patency rate of saphenous vein grafts for myocardial revascularization is poor (50% at 10 years). Half of the patent grafts develop severe atherosclerosis. In this paper, we report on an implantation technique and an in vivo evaluation of a device that creates a ventriculocoronary artery bypass (VCAB), a permanent transmyocardial channel between the left ventricle and a coronary artery. METHODS: An L-shaped titanium tube with an exterior polyester cuff was implanted from the base of the left ventricle to the proximal left anterior descending coronary artery in 11 juvenile domestic pigs using a beating heart approach. Flow rates were measured at implantation. Patency was assessed when explanted at 2 weeks. RESULTS: The flow rate through the device after implantation was 76% of baseline. Forward flow occurred during systole. The patency rate was 91% at 2 weeks. Histologic analysis showed the formation of an organizing tissue at the coronary interface. CONCLUSIONS: These preliminary studies show the promise of perfusing ischemic myocardium with systolic flow. Patency of the transmyocardial titanium conduit was excellent at 2 weeks and warrants longer duration studies.