Efficacy and Mechanism of Coronary Vein Bypass Grafting to Improve Myocardial Ischemia Using Internal Mammary　Artery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YU Yang , LI Haitao , GU Chengxiong , GAO Mingxin , ZHANG Fan.

Department of Cardiac Surgery, Beijing An Zhen Hospital, Capital Medical University, Beijing 100029, P. R. China;

Corresponding author：

Keywords：

Diffuse coronary artery disease; 　Internal mammary artery; 　Selective coronary vein bypass grafting

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Objective　To evaluate the outcome and explore the mechanism of coronary vein bypass grafting （CVBG） performed by　anastomosing the right internal mammary artery with the middle cardiac vein via off-pump surgery.　Methods　Twelve Chinese experimental miniswines （either male or female, age from 7 to 10 months, body weight 40±5 kg） with severely diffuse stenosis in the right coronary artery were randomly divided into control group and experiment group with 6 miniswines in each group, using a random number table method. CVBG was performed in the experiment group and sham surgery was performed in the control group. To assess cardiac function, graft flow, graft patency and micro-circulation reperfusion of ischemia myocardium, following measurements were conducted. Eight weeks after right coronary endarterectomy, transthoracic echocardiography was performed for both groups. Coronary angiography, graft flow and echocardiography were performed or measured 6 hours and 3 months after CVBG or sham surgery. Measurement of myocardial blood flow with non-radioactive colored microspheres was also conducted 3 months after surgery for two groups.　Results　There was no statistical difference in cardiac function 8 weeks after right coronary endarterectomy between the two groups. There were significant improvements in cardiac systolic and diastolic function （ejection fraction 3 months after operation: 52%±6% vs. 44%±5%, t=-2.500, P=0.031） in the experiment group after CVBG compared with the control group. Graft flow of the experiment group 6 hours and 3 months after CVBG were 44.50±5.86 ml/min and 43.33±5.01ml/min respectively （P=0.718）, and pulsatility index （PI） was 0.73±0.14 and 0.80±0.14 respectively（P=0.858）. Internal mammary artery grafts and the anastomoses were all patent without stenosis, documented by coronary artery angiography for the experiment group 6 hours and 3 months after CVBG. Myocardial flow in all aspects especially in the subendocardial layer, estimated by non-radioactive colored microsphere injection, was significantly higher in the experiment group after CVBG than that of the control group, transmural flow was 0.33±0.05ml/（g • min） vs. 0.19±0.03 ml/（g • min）（P＜0.05）.　Conclusion　Ischemic conditions of the myocardium can be relieved by CVBG using internal mammary artery in a short-term to medium-term period. The mechanism may be due to improvement of the myocardial micro-circulation.

Citation： YU Yang,LI Haitao,GU Chengxiong,GAO Mingxin,ZHANG Fan.. Efficacy and Mechanism of Coronary Vein Bypass Grafting to Improve Myocardial Ischemia Using Internal Mammary　Artery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2012, 19(5): 538-542. doi: Copy

1.	Database Syst Rev， 2009， 21 （1）：CD003712.
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3.	Zajtchuk R， William HH， Miller JG， et al. Revascularization of the heart through the coronary veins. Ann Thorac Surg， 1976， 21 （4）：318-321.
4.	Benedict JS， Buhl TL， Henney RP. Cardiac vein myocardial revascularization. An experimental study and report of 3 clinical cases. Ann Thorac Surg， 1975， 20 （5）：550-557.
5.	Chowdhry MF， Davies J， Mccance A， et al. Lack of durability of surgical arterialization of coronary veins for the treatment of ischemic heart disease. J Card Surg， 2005， 20 （4）：326-328.
6.	陈良龙，王欣，罗育坤，等．非放射性彩色微球测定心肌血流量实验研究．中国循环杂志， 1998， 13 （2）：13-15．.
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12.	Oesterle SN， Reifart N， Hauptmann E， et al. Percutaneous in situ coronary venous arterialization：report of the ﬁrst human catheter-based coronary artery bypass. Circulation， 2001， 103 （21）：2539-2543.
13.	Raake P， Hinkel R， Kupatt C， et al. Percutaneous approach to a stent-based ventricle to coronary vein bypass （venous VPASS）：comparison to catheter-based selective pressure-regulated retro-infusion of the coronary vein. Eur Heart J， 2005， 26 （12）：1228-1234.
14.	Benedict JS， Buhl TL， Henney RP. Cardiac vein myocardial revascularization. An experimental study and report of 3 clinical cases. Ann Thorac Surg， 1975， 20 （5）：550-557.
15.	Resetar ME， Ullmann C， Broeske P， et al. Selective arterialization of a cardiac vein in a model of cardiac microangiopathy and macroangiopathy in sheep. J Thorac Cardiovasc Surg， 2007， 133 （5）：1252-1256.
16.	Fitzgerald PJ， Hayase M， Yeung AC， et al. New approaches and conduits：in situ venous arterialization and coronary artery bypass. Curr Interv Cardiol Rep， 1999， 1 （2）：127-137.
17.	Choy JS， Kassab GS. A novel strategy for increasing wall thickness of coronary venules prior to retroperfusion. Am J Physiol Heart Circ Physiol， 2006， 291 （2）：H972-H978.
18.	Yu Y， Qi DN， Gu CX. Sequential saphenous vein grafting combined with selective arterialization of middle cardiac vein during off-pump coronary artery bypass surgery. Chin Med J （Engl）， 2010， 123 （19）：2739-2740.
19.	Rankin JS， Tuttle RH， Wechsler AS， et al. Techniques and benefits of multiple internal mammary artery bypass at 20 years of follow-up. Ann Thorac Surg， 2007， 83 （3）：1008-1014.
20.	Kassab GS， Navia JA， March K， et al. Coronary venous retroperfusion：an old concept， a new approach. J Appl Physiol， 2008， 104 （5）：1266-1272.
21.	Hochberg MS. Hemodynamic evaluation of selective arterialization of the coronary venous system. An experimental study of myocardial perfusion utilizing radioactive microspheres. J Thorac Cardiovasc Surg， 1977， 74 （5）：774-783.
22.	Hammond GL， Davies AL， Austen WG. Retrograde coronary sinus perfusion：a method of myocardial protection in the dog during left coronary artery occlusion. Ann Surg， 1967， 166 （1）：39-47.
23.	Rhodes GR， Syracuse DC， Mcintosh CL. Evaluation of regional myocardial nutrient perfusion following selective retrograde arterialization of the coronary vein. Ann Thorac Surg， 1978， 25 （4）：329-335.
24.	Ido A， Hasebe N， Matsuhashi H， et al. Coronary sinus occlusion enhances coronary collateral flow and reduces　subendocardial ischemia. Am J Physiol Heart Circ Physiol， 2001， 280 （3）：H1361-H1367.
25.	于洋，顾承雄，李海涛．非体外循环双乳内动脉序贯旁路移植加选择性心中静脉动脉化手术的疗效分析．中国胸心血管外科临床杂志， 2011， 18 （5）：394-398．.
26.	Yu Y， Yan XL， Wei H， et al. Off-pump sequential bilateral internal mammary artery grafting combined with selective　arterialization of the coronary venous system. Chin Med J （Engl）， 2011， 124 （19）：3017-3021.

1. Database Syst Rev， 2009， 21 （1）：CD003712.
2. 　Harig F， Schmidt J， Hoyer E， et al. Long-term evaluation of a selective retrograde coronary venous perfusion model in pigs （Sus scrofa domestica）. Comp Med， 2011， 61 （2）：150-157.
3. 　Zajtchuk R， William HH， Miller JG， et al. Revascularization of the heart through the coronary veins. Ann Thorac Surg， 1976， 21 （4）：318-321.
4. 　Benedict JS， Buhl TL， Henney RP. Cardiac vein myocardial revascularization. An experimental study and report of 3 clinical cases. Ann Thorac Surg， 1975， 20 （5）：550-557.
5. 　Chowdhry MF， Davies J， Mccance A， et al. Lack of durability of surgical arterialization of coronary veins for the treatment of ischemic heart disease. J Card Surg， 2005， 20 （4）：326-328.
6. 　陈良龙，王欣，罗育坤，等．非放射性彩色微球测定心肌血流量实验研究．中国循环杂志， 1998， 13 （2）：13-15．.
7. 　Briones E， Lacalle JR， Marin I. Transmyocardial laser revascularization versus medical therapy for refractory angina. Cochrane.
8. 　Stewart DJ， Kutryk MJ， Fitchett D， et al. VEGF gene therapy fails to improve perfusion of ischemic myocardium in patients with advanced coronary disease：results of the NORTHERN trial. Mol Ther， 2009， 17 （6）：1109-1115.
9. 　Akgun S， Isbir CS， Yildirim T， et al. Results of adjunctive coronary endarterectomy in 548 patients. Heart Surg Forum， 2008， 11 （2）：E66-E70.
10. 　Mohl W， Milasinovic D， Burki S. Myocardial protection via the coronary venous route. New Solutions for the Heart. Vienna， Austria：　Springer Vienna. 2011. 221-248.
11. 　Møller CH， Nørgaard MA， Gøtze JP， et al. Selective retrograde venous revascularization of the myocardium when PCI or CABG is impossible：investigation in a porcine model. Heart Surg Forum， 2008， 11 （2）：E99-104.
12. 　Oesterle SN， Reifart N， Hauptmann E， et al. Percutaneous in situ coronary venous arterialization：report of the ﬁrst human catheter-based coronary artery bypass. Circulation， 2001， 103 （21）：2539-2543.
13. 　Raake P， Hinkel R， Kupatt C， et al. Percutaneous approach to a stent-based ventricle to coronary vein bypass （venous VPASS）：comparison to catheter-based selective pressure-regulated retro-infusion of the coronary vein. Eur Heart J， 2005， 26 （12）：1228-1234.
14. 　Benedict JS， Buhl TL， Henney RP. Cardiac vein myocardial revascularization. An experimental study and report of 3 clinical cases. Ann Thorac Surg， 1975， 20 （5）：550-557.
15. 　Resetar ME， Ullmann C， Broeske P， et al. Selective arterialization of a cardiac vein in a model of cardiac microangiopathy and macroangiopathy in sheep. J Thorac Cardiovasc Surg， 2007， 133 （5）：1252-1256.
16. 　Fitzgerald PJ， Hayase M， Yeung AC， et al. New approaches and conduits：in situ venous arterialization and coronary artery bypass. Curr Interv Cardiol Rep， 1999， 1 （2）：127-137.
17. 　Choy JS， Kassab GS. A novel strategy for increasing wall thickness of coronary venules prior to retroperfusion. Am J Physiol Heart Circ Physiol， 2006， 291 （2）：H972-H978.
18. 　Yu Y， Qi DN， Gu CX. Sequential saphenous vein grafting combined with selective arterialization of middle cardiac vein during off-pump coronary artery bypass surgery. Chin Med J （Engl）， 2010， 123 （19）：2739-2740.
19. 　Rankin JS， Tuttle RH， Wechsler AS， et al. Techniques and benefits of multiple internal mammary artery bypass at 20 years of follow-up. Ann Thorac Surg， 2007， 83 （3）：1008-1014.
20. 　Kassab GS， Navia JA， March K， et al. Coronary venous retroperfusion：an old concept， a new approach. J Appl Physiol， 2008， 104 （5）：1266-1272.
21. 　Hochberg MS. Hemodynamic evaluation of selective arterialization of the coronary venous system. An experimental study of myocardial perfusion utilizing radioactive microspheres. J Thorac Cardiovasc Surg， 1977， 74 （5）：774-783.
22. 　Hammond GL， Davies AL， Austen WG. Retrograde coronary sinus perfusion：a method of myocardial protection in the dog during left coronary artery occlusion. Ann Surg， 1967， 166 （1）：39-47.
23. 　Rhodes GR， Syracuse DC， Mcintosh CL. Evaluation of regional myocardial nutrient perfusion following selective retrograde arterialization of the coronary vein. Ann Thorac Surg， 1978， 25 （4）：329-335.
24. 　Ido A， Hasebe N， Matsuhashi H， et al. Coronary sinus occlusion enhances coronary collateral flow and reduces　subendocardial ischemia. Am J Physiol Heart Circ Physiol， 2001， 280 （3）：H1361-H1367.
25. 　于洋，顾承雄，李海涛．非体外循环双乳内动脉序贯旁路移植加选择性心中静脉动脉化手术的疗效分析．中国胸心血管外科临床杂志， 2011， 18 （5）：394-398．.
26. 　Yu Y， Yan XL， Wei H， et al. Off-pump sequential bilateral internal mammary artery grafting combined with selective　arterialization of the coronary venous system. Chin Med J （Engl）， 2011， 124 （19）：3017-3021.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Efficacy and Mechanism of Coronary Vein Bypass Grafting to Improve Myocardial Ischemia Using Internal Mammary　Artery

Abstract Full text Figures/Tables Video References Cited by

Format

Content

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Efficacy and Mechanism of Coronary Vein Bypass Grafting to Improve Myocardial Ischemia Using Internal Mammary Artery

Abstract Full text Figures/Tables Video References Cited by

Format

Content

Efficacy and Mechanism of Coronary Vein Bypass Grafting to Improve Myocardial Ischemia Using Internal Mammary　Artery