心肌内左心室至冠状动脉支架：一种治疗冠状动脉疾病的新方法。

Yi Geng-Hua, Becker Eva Maria, Dang Nicholas C, He Kun-Lun, Cahalan Patrick, Gu Anguo, Lee Myung Jae, Yue Kenward, Burkhoff Daniel, Wang Jie

Division of Cardiology, Department of Medicine, Columbia University, College of Physicians and Surgeons, New York, New York 10032, USA.

Ann Thorac Surg. 2005 Aug;80(2):600-6. doi: 10.1016/j.athoracsur.2005.02.073.

BACKGROUND

The direct intramyocardial left ventricle-to-coronary artery stent may provide an optional minimally invasive technique for coronary artery bypass graft surgery. We seek to test whether blood flow and regional myocardial function improve with this stent in totally ischemic myocardium.

METHODS

The stent device was implanted in 8 anesthetized dogs using an open chest approach, arteriotomy of the proximal left anterior descending coronary artery, and connection of the vessel to the left ventricular chamber. Regional coronary blood flow and myocardial function were monitored under three conditions: normal coronary flow (baseline), coronary ligation, and stent flow.

RESULTS

Left anterior descending coronary ligation markedly reduced coronary artery blood flow and regional myocardial function. With flow solely from the stent, the blood flow pattern changed to one with high peak forward flow during systole compared with baseline (94.8 +/- 48.9 versus 56.8 +/- 21.1 mL/min; p < 0.05) and one with significant negative backflow during diastole compared with baseline (-37.4 +/- 23.1 versus 11.3 +/- 17.2 mL/min; p < 0.05). However, the resultant mean forward flow increased to approximately 50% of baseline compared with less than 5% of baseline after coronary ligation. Regional myocardial function diminished entirely after coronary ligation, but recovered to approximately 60% of baseline with the stent. Normal systemic hemodynamics and global ventricular contractile function were maintained with the stent.

CONCLUSIONS

The left ventricle-to-coronary artery stent is a simple and readily deployable device that allows the perfusion of epicardial vessels directly from the left ventricle and can provide significant blood flow to improve the performance of ischemic myocardium. It may provide an effective, alternative means of treating coronary artery disease when standard coronary artery bypass graft surgery is not suitable.

背景

直接心肌内左心室至冠状动脉支架可为冠状动脉旁路移植术提供一种可选的微创技术。我们试图测试在完全缺血心肌中使用该支架是否能改善血流和局部心肌功能。

方法

采用开胸方法，在8只麻醉犬身上植入支架装置，切开左前降支冠状动脉近端并将血管与左心室腔相连。在三种情况下监测局部冠状动脉血流和心肌功能：正常冠状动脉血流（基线）、冠状动脉结扎和支架血流。

结果

左前降支冠状动脉结扎显著降低了冠状动脉血流和局部心肌功能。仅通过支架供血时，血流模式发生改变，与基线相比，收缩期出现高峰正向血流（94.8±48.9对56.8±21.1毫升/分钟；p<0.05），舒张期出现显著负向反流（-37.4±23.1对11.3±17.2毫升/分钟；p<0.05）。然而，与冠状动脉结扎后低于基线5%相比，由此产生的平均正向血流增加至基线的约50%。冠状动脉结扎后局部心肌功能完全丧失，但使用支架后恢复至基线的约60%。使用支架维持了正常的全身血流动力学和整体心室收缩功能。