Ahmed Elwatidy F1,2*, Jeffrey Danetz1, Ibrahim Hegab M1, Cynthia Allen1, Mohamed Alfagih R2 and Anwar Abd-Elfattah S1
1Department of Surgery, Medical College of Virginia Virginia Commonwealth University, USA
2Department of Surgery, Prince Sultan Cardiac Center Riyadh, Saudi Arabia
Background: Till date there is no optimal coronary revascularisation technique for diffuse coronary artery disease. This study was conducted to proof the concept of total coronary venous retro perfusion, for end-stage coronary artery disease patients. The coronary venous circulation is arterialised while the coronary arteries drain the heart to the right atrium “Coronary Switch”.
Methods: Sixteen adult Mongrel dogs were used. After preparation for bypass, the heart was instrumented with minor axis son micrometric crystals, carotid and left ventricular Millar catheters. Colored microspheres were used for Regional Myocardial Blood Flow “RMBF” measurements. After aortic cross clamping and cardioplegia, the coronary sinus ostium was closed, and then a 3 mm Gore-Tex tube was anastomosed to the coronary sinus and its top-end to the aorta. A similar tube was sequentially anastomosed between the three coronary arteries and ended in the right atrium. Coronary switch was established by occluding the coronary arteries proximal to the anastomoses.Results: The mean left ventricular function was 85,820.1 dyn. Cm2 "Preoperative" versus 87,984.2 "Postoperative" (p=NS). The RMBF was 1.38 ± 1.1 ml/min/gm “Preop” versus 1.44 ± 0.98 in combined "ante/retro flow" and 1.58 ± 0.29, 1.28 ± 0.19, and 1.45 ± 0.35 at 60, 120, 180 minutes after "Coronary Switch" (p=NS).
Conclusion: Primary results support “Coronary Switch” as an alternative therapeutic modality for end-stage coronary artery disease. Survival studies and long-term follow-up are needed.
Ahmed Elwatidy F, Danetz J, Ibrahim Hegab M, Allen C, Mohamed Alfagih R, Anwar Abd-Elfattah S. Coronary Switch: Total Reversal of Coronary Circulation in Acute Canine Model. Clin Surg. 2018; 3: 2124.