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

Background: The long-term patency rate of saphenous vein grafts for myocard ial 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 ventriculoc oronary artery bypass (VCAB(TM))*, a permanent transmyocardial channel betw een the left ventricle and a coronary artery. Methods: An L-shaped titanium tube with an exterior polyester cuff was impl anted from the base of the left ventricle to the proximal left anterior des cending coronary artery in 11 juvenile domestic pigs using a beating heart approach. Flow rates were measured at implantation. Patency was assessed wh en explanted at two weeks. Results: The flow rate through the device after implantation was 76% of bas eline. Forward flow occurred during systole. The patency rate was 91% at tw o weeks. Histologic analysis showed the formation of an organizing tissue a t the coronary interface. Conclusions: These preliminary studies show the promise of perfusing ischem ic myocardium with systolic flow. Patency of the transmyocardial titanium c onduit was excellent at two weeks and warrants longer duration studies.