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Developments in cardiac surgery
MONDAY 9/15/03 9:00 –11:00
AM
and 2:00 – 4:00
Developments in Cardiac Surgery Monday, September 15, 2003 9:00-11:00 AM 2:00-4:00 PM Exhibit Hall B on the Lower Level (Abstract nos. 286 –292)
TCT-286 Comparisons Among Coronary Artery Bypass Graft Patients Receiving All-Arterial, All-Venous, or Mixed Grafts: Does It Make a Difference in Immediate Clinical Outcomes? P.P. Brown1, M.R. Katz2, A.W. Simon3, S.L. Battaglia4, L.G. Tarkington4, S.D. Culler5, E.R. Becker5. 1Centennial Medical Center, Nashville, Tennessee, USA; 2Henrico Doctors’ Hospital, Richmond, Virginia, USA; 3Cardiac Data Solutions, Atlanta, Georgia, USA; 4HCA, Inc., Nashville, Tennessee, USA; 5Emory University, Atlanta, Georgia, USA. Background: The choice among alternative conduits in coronary artery bypass graft (CABG) patients raises questions about differences in immediate outcomes of the different conduits. Methods: A retrospective analysis of 94,497 consecutive CABG patients using the HCA Casemix database (HCA, Inc., Nashville, Tennessee, USA) from 1998 to 2002 was performed. Grafts, complications, comorbid conditions, and procedural characteristics were identified using the ICD-9 CM codes. Adverse outcomes were analyzed using logistic regression analysis to evaluate the impact of the type of graft on clinical outcomes experienced during the CABG hospitalization after controlling for age, gender, and 44 comorbid and procedural conditions. Results: 4.9% of the CABG patients received all-arterial conduits, while 21.3% received all-venous conduits, and 73.7% received mixed conduits. The all-arterial group averaged 1.2 vessels bypassed, the all-venous group averaged 2.7 vessels bypassed, and the mixed group averaged 3.6 vessels bypassed. Of the all-arterial group, 50% was performed off-pump while 13.7% of the all-venous group and 16.4% of the mixed group were done off-pump. Logistic regression results demonstrated that compared to the all-arterial group, the all-venous group had a 54% (p ⬍0.001) increase in mortality and a 28% (p ⬍0.001) increase in acute renal failure. The all-venous group was also 20% (p ⬍0.001) less likely to be discharged home than the all-arterial group. However, there were no significant differences in outcomes between the all-arterial group and the mixed group. Conclusion: It does appear that after controlling for age, gender, comorbidities, number of bypassed vessels, and use of cardiopulmonary bypass, having at least one arterial conduit significantly improves patient mortality and acute renal failure. It may be that these differences are due to both graft patency, as well as less manipulation of the aorta for proximal anastomosis than all-venous conduits require. Further research needs to be done to establish the mechanism.
The American Journal of Cardiology姞
PM
(Exhibit Hall B on the Lower Level)
TCT-287 Percutaneous Coronary Intervention Versus Coronary Artery Bypass Graft for Medically Refractory Ischemia Among Patients Who Required an Intraaortic Balloon Pump to Stabilize. D.A. Morrison,1 J. Sacks,2 G. Sethi,1 W. Henderson,3 S. Sedlis,4 for the Angina with Extremely Serious Operative Mortality Evaluation (AWESOME) Investigators, US Veterans Affairs Cooperative Studies Program, USA 1SAVAHCS and University of Arizona, Tucson, Arizona, USA; 2Hines VA CSPCCS, Hines, Illinois, USA; 3University of Colorado Health Sciences Center, Aurora, Colorado, USA; 4Manhattan VA and New York University, New York, New York, USA. Background: Patients who are hemodynamically unstable from myocardial ischemia are likely to benefit from revascularization, but are at increased risk of short-term mortality. Methods: One hundred AWESOME patients underwent revascularization with intraaortic balloon pump (IABP) support. Overall, 44 patients underwent coronary artery bypass graft (CABG) and 56 underwent percutaneous coronary intervention (PCI). Of these, 9 were randomly allocated to either CABG (4) or PCI (5). The random allocations were based on the need for IABP to stabilize prior to revascularization. For patients who underwent either CABG or PCI, we compared the following: clinical and coronary anatomic features, using t tests and 2 tests; and long-term outcomes, using Kaplan-Meier survival plots and log-rank tests. Results: Selected clinical and coronary anatomic variables were as follows: Variable CABG (%), PCI (%), p: MI ⬍7 days 53% 65% 0.12; New ST changes 88% 88% 0.62; Prior CABG 18% 33% 0.05; LVEF ⬍0.35 23% 39% 0.05; Left main ⬎50% 38% 16% 0.01. By log-rank testing, the 3-year survival curves of these two relatively small groups were not significantly different (p ⫽ 0.16). The Kaplan-Meier plots revealed that both groups had ⬎50% survival past 3 years. Conclusion: It is extremely difficult to convince caregivers or patients to allow random allocation between CABG and PCI for patients who are hemodynamically unstable enough to require IABP. However, despite this degree of instability, more than one half of both groups were still alive 3 years after revascularization.
TCT-288 Comparison of a Spiral Flow–Inducing Vascular Graft with a Standard Graft in a Porcine Thoracoabdominal Bypass. J.G. Houston1, C. Sarran2, J.B.C. Dick1, P.A. Stonebridge1. 1Tayside University Hospitals NHS Trust, Dundee, United Kingdom; 2Tayside Flow Technologies Ltd., Dundee, United Kingdom. Background: Spiral blood flow in arteries is a normal finding. Loss of spiral flow is associated with atheromatous disease. Spiral flow distal to a redesigned vascular bypass is expected to restore spiral flow in the distal native vessel with reduced wall stress. The aim of this study was to compare the flow patterns induced by this redesigned vascular graft to a standard graft in a thoracoabdominal porcine model. Methods: A thoracoabdominal bypass with distal tie was performed in 20 Haniford minipigs. Ten pigs received an 8-mm spiral–inducing SLF polyester (Syklistenes Landsforening, Oslo, Norway) graft; the others received an 8-mm standard polyester graft. Color flow Doppler ultrasound was performed. Numerical image processing and image analysis produced transverse velocity profiles at different key positions: upstream and downstream from the native vessels pre-implantation; and upstream and downstream from the grafts postimplantation. Assessment parameters were devised to quantify the improvements in flow and the efficiency of the vessels; namely, the gross improvement, graft efficiency, and native vessel efficiency were determined. Results: The mean peak spiral velocities were 11 (SD ⫽ 12) cm/sec and 5 (SD ⫽ 3) cm/sec for the spiral grafts and standard grafts,
SEPTEMBER 15–17, 2003
TCT ABSTRACTS/Poster
125L
P O S T E R A B S T R A C T S
MONDAY 9/15/03 9:00 –11:00
AM
and 2:00 – 4:00
respectively. These were significantly different (p ⫽ 0.02). Spiral graft implants presented with an average gross improvement of 11% while control implants presented at ⫺87%. Spiral graft implants presented with an average graft efficiency of ⫺8% while control implants presented at ⫺54%. Spiral graft implants presented with an average efficiency increase of 142% while the control implants presented at 87%. Fitting the preclinical data to different models of spiral flow was attempted. Conclusion: From this analysis, it was concluded that spiral grafts were more efficient than the control grafts at maintaining and improving downstream spiral flow characteristics.
PM
(Exhibit Hall B on the Lower Level)
re-PCI (n ⫽ 123) or coronary artery bypass graft (CABG) (n ⫽ 16). The long-term follow-up between patients treated with coronary bypass grafting or re-PCI was compared. Results: In patients treated with re-PCI, the cumulative survival rate was 98.3% and 92.7% at 1 and 5 years, respectively, compared with 87.5% in those initially treated with CABG (log-rank test: p ⫽
TCT-289 Intraoperative Coronary Angiography Leads to Higher Success Rates in Minimal Invasive and Off-Pump Coronary Artery Bypass Surgery. G.J. Friedrich, G. Laufer, N. Bonaros, O. Pachinger, J. Bonatti. Cardiology and Cardiosurgery Departments, Innsbruck University Hospital, Innsbruck, Austria.
P O S T E R A B S T R A C T S
Background: Minimal invasive coronary artery bypass (MIDCAB) and off-pump coronary artery bypass (OPCAB) surgery require immediate and long-term proof of graft patency to compete with established on-pump surgery or percutaneous revascularization procedures. Previous reports with postoperative angiography only describe immediate results and a high rate of surgical revision. Methods: We investigated 30 coronary bypass grafts in 22 patients (19 male, 3 female) in 15 OPCAB and 7 MIDCAB surgical procedures. Eligibility of patients was determined during cardiac surgery and cardiology conferences considering individual anatomic and clinical features. Transfemoral intraoperative coronary angiography was performed using an OEC mobile C-arm (General Electric Medical Systems, Waukesha, Wisconsin, USA and Toronto, Canada). Two orthogonal angiographic views were selected as standard projections. After 6 months, 15 of 22 patients underwent follow-up angiography. Results: Except for 2 venous grafts, all target arteries and grafts could be visualized by intraoperative angiography. In 91% (20 of 22 patients), severe spasm of native or graft vessel segments occurred; 19 of 20 responded to the application of intracoronary nitroglycerine. Three grafts were shown to be severely stenosed and required immediate surgical revision. No intraoperative angiography-related complications occurred. Follow-up angiography revealed patent grafts in all 15 patients; in one case, however, there was need for an angioplasty of a new significant stenotic lesion in a previously normal coronary artery. Vessel spasm during follow-up was less frequent (33%). Conclusion: Intraoperative coronary angiography, performed with intraluminal nitroglycerine, provides nonconfounding imaging of bypass grafting in MIDCAB and OPCAB surgery. This approach may improve the outcome of these innovative techniques.
TCT-290 Proximal Left Anterior Descending Coronary Artery In-Stent Restenosis: Should Coronary Bypass Grafting Necessarily Be Considered? R. Moreno, J. Pe´ ez, M.-J. Perez-Vizcayno, F. Alfonso, R. Hernandez, J. Escaned, M. Sabate, C. Ban˜ uelos, C. Macaya. Hospital Clinico San Carlos, Madrid, Spain. Background: Once a first interventional procedure has failed, patients with proximal left anterior descending coronary artery (LAD) in-stent restenosis (ISR) are frequently sent for surgical revascularization. We evaluated the long-term outcome of patients with proximal LAD ISR treated with repeat percutaneous coronary intervention (re-PCI), a new percutaneous procedure. Methods: We evaluated the long-term follow-up (3.3 years) of 249 patients with proximal LAD ISR (⬎50% diameter stenosis). Out of the total, 139 (56%) underwent a new revascularization procedure, either
126L
The American Journal of Cardiology姞
0.103; Breslow’s estimator: p ⫽ 0.023). The cumulative probability of being free from CABG in patients treated with re-PCI was 94.5% and 89.3% at 1 and 5 years, respectively, whereas freedom from a new CABG in patients initially treated with CABG was 93.7% both at 1 and 5 years (log-rank test: p ⫽ 0.8988; Breslow’s estimator: p ⫽ 0.8614). Conclusion: In patients with proximal LAD ISR requiring coronary revascularization, a new PCI was at least as safe as CABG at long-term follow-up. A new PCI in these patients was associated with a very good long-term outcome, with few patients needing CABG.
TCT-291 Cell-Patch Cardiomyoplasty and Omentopexy As an Adjunct of Coronary Artery Bypass. S. Taheri1, H. Ashraf1, H. Naughton1, A. Litwin1, Q. Zhao2. 1Kaleida Health Millard Fillmore Gates Circle Hospital, Buffalo, New York, USA; 2Shanghai Institute of Cardiovascular Diseases, Shanghai, China. Background: Loss of myocytes as a result of coronary artery occlusion is a major effect of the genesis of cardiac failure. Laboratory results of experimental cell-patch cardiomyoplasty and omentopexy show regeneration, viability, synchronous contraction, and migration of stem cells into infarcted myocardium. These encouraging results prompted us to use autologous cell-patch cardiomyoplasty and omentopexy during coronary bypass on 8 patients (New York Heart Association classes II, III) (6 male, 2 female). Average patient age was 65 years. Methods: During coronary artery bypass, the upper abdomen was opened via midline incision, which was extended to the umbilicus to expose and tailor the greater omentum to reach the mediastinum. Six pieces of rectus muscle measuring 11 ⫻ 11 ⫻ 2 cm were obtained, applied, and sutured to the dyskinetic ventricular wall, and reinforced by suturing the greater omentum over the muscle patches to the myocardium. Results: No deaths occurred among this group of patients. All had increased daily activities free from chest pain. Work capacity showed marked improvement with exercise testing. Regular daily activities were resumed 6 months after surgery. Individualized follow-up illustrated evidence of synchronous contraction of cell patches, higher ejection fraction, and improved perfusion with viability in grafted scar tissue, as proven by positron emission tomography (PET) and computed tomography angiography. Conclusion: Cell patch cardiomyoplasty and omentopexy seemed to limit infarction remodeling of the left ventricle, increase ejection fraction, and improve contraction of dyskinetic ventricular wall. It revealed viable regenerated muscle with increased perfusion, which was determined by PET scanning.
TCT-292 (withdrawn)
SEPTEMBER 15–17, 2003
TCT ABSTRACTS/Poster
AM
and 2:00 – 4:00
Developments in Cardiac Surgery Monday, September 15, 2003 9:00-11:00 AM 2:00-4:00 PM Exhibit Hall B on the Lower Level (Abstract nos. 286 –292)
TCT-286 Comparisons Among Coronary Artery Bypass Graft Patients Receiving All-Arterial, All-Venous, or Mixed Grafts: Does It Make a Difference in Immediate Clinical Outcomes? P.P. Brown1, M.R. Katz2, A.W. Simon3, S.L. Battaglia4, L.G. Tarkington4, S.D. Culler5, E.R. Becker5. 1Centennial Medical Center, Nashville, Tennessee, USA; 2Henrico Doctors’ Hospital, Richmond, Virginia, USA; 3Cardiac Data Solutions, Atlanta, Georgia, USA; 4HCA, Inc., Nashville, Tennessee, USA; 5Emory University, Atlanta, Georgia, USA. Background: The choice among alternative conduits in coronary artery bypass graft (CABG) patients raises questions about differences in immediate outcomes of the different conduits. Methods: A retrospective analysis of 94,497 consecutive CABG patients using the HCA Casemix database (HCA, Inc., Nashville, Tennessee, USA) from 1998 to 2002 was performed. Grafts, complications, comorbid conditions, and procedural characteristics were identified using the ICD-9 CM codes. Adverse outcomes were analyzed using logistic regression analysis to evaluate the impact of the type of graft on clinical outcomes experienced during the CABG hospitalization after controlling for age, gender, and 44 comorbid and procedural conditions. Results: 4.9% of the CABG patients received all-arterial conduits, while 21.3% received all-venous conduits, and 73.7% received mixed conduits. The all-arterial group averaged 1.2 vessels bypassed, the all-venous group averaged 2.7 vessels bypassed, and the mixed group averaged 3.6 vessels bypassed. Of the all-arterial group, 50% was performed off-pump while 13.7% of the all-venous group and 16.4% of the mixed group were done off-pump. Logistic regression results demonstrated that compared to the all-arterial group, the all-venous group had a 54% (p ⬍0.001) increase in mortality and a 28% (p ⬍0.001) increase in acute renal failure. The all-venous group was also 20% (p ⬍0.001) less likely to be discharged home than the all-arterial group. However, there were no significant differences in outcomes between the all-arterial group and the mixed group. Conclusion: It does appear that after controlling for age, gender, comorbidities, number of bypassed vessels, and use of cardiopulmonary bypass, having at least one arterial conduit significantly improves patient mortality and acute renal failure. It may be that these differences are due to both graft patency, as well as less manipulation of the aorta for proximal anastomosis than all-venous conduits require. Further research needs to be done to establish the mechanism.
The American Journal of Cardiology姞
PM
(Exhibit Hall B on the Lower Level)
TCT-287 Percutaneous Coronary Intervention Versus Coronary Artery Bypass Graft for Medically Refractory Ischemia Among Patients Who Required an Intraaortic Balloon Pump to Stabilize. D.A. Morrison,1 J. Sacks,2 G. Sethi,1 W. Henderson,3 S. Sedlis,4 for the Angina with Extremely Serious Operative Mortality Evaluation (AWESOME) Investigators, US Veterans Affairs Cooperative Studies Program, USA 1SAVAHCS and University of Arizona, Tucson, Arizona, USA; 2Hines VA CSPCCS, Hines, Illinois, USA; 3University of Colorado Health Sciences Center, Aurora, Colorado, USA; 4Manhattan VA and New York University, New York, New York, USA. Background: Patients who are hemodynamically unstable from myocardial ischemia are likely to benefit from revascularization, but are at increased risk of short-term mortality. Methods: One hundred AWESOME patients underwent revascularization with intraaortic balloon pump (IABP) support. Overall, 44 patients underwent coronary artery bypass graft (CABG) and 56 underwent percutaneous coronary intervention (PCI). Of these, 9 were randomly allocated to either CABG (4) or PCI (5). The random allocations were based on the need for IABP to stabilize prior to revascularization. For patients who underwent either CABG or PCI, we compared the following: clinical and coronary anatomic features, using t tests and 2 tests; and long-term outcomes, using Kaplan-Meier survival plots and log-rank tests. Results: Selected clinical and coronary anatomic variables were as follows: Variable CABG (%), PCI (%), p: MI ⬍7 days 53% 65% 0.12; New ST changes 88% 88% 0.62; Prior CABG 18% 33% 0.05; LVEF ⬍0.35 23% 39% 0.05; Left main ⬎50% 38% 16% 0.01. By log-rank testing, the 3-year survival curves of these two relatively small groups were not significantly different (p ⫽ 0.16). The Kaplan-Meier plots revealed that both groups had ⬎50% survival past 3 years. Conclusion: It is extremely difficult to convince caregivers or patients to allow random allocation between CABG and PCI for patients who are hemodynamically unstable enough to require IABP. However, despite this degree of instability, more than one half of both groups were still alive 3 years after revascularization.
TCT-288 Comparison of a Spiral Flow–Inducing Vascular Graft with a Standard Graft in a Porcine Thoracoabdominal Bypass. J.G. Houston1, C. Sarran2, J.B.C. Dick1, P.A. Stonebridge1. 1Tayside University Hospitals NHS Trust, Dundee, United Kingdom; 2Tayside Flow Technologies Ltd., Dundee, United Kingdom. Background: Spiral blood flow in arteries is a normal finding. Loss of spiral flow is associated with atheromatous disease. Spiral flow distal to a redesigned vascular bypass is expected to restore spiral flow in the distal native vessel with reduced wall stress. The aim of this study was to compare the flow patterns induced by this redesigned vascular graft to a standard graft in a thoracoabdominal porcine model. Methods: A thoracoabdominal bypass with distal tie was performed in 20 Haniford minipigs. Ten pigs received an 8-mm spiral–inducing SLF polyester (Syklistenes Landsforening, Oslo, Norway) graft; the others received an 8-mm standard polyester graft. Color flow Doppler ultrasound was performed. Numerical image processing and image analysis produced transverse velocity profiles at different key positions: upstream and downstream from the native vessels pre-implantation; and upstream and downstream from the grafts postimplantation. Assessment parameters were devised to quantify the improvements in flow and the efficiency of the vessels; namely, the gross improvement, graft efficiency, and native vessel efficiency were determined. Results: The mean peak spiral velocities were 11 (SD ⫽ 12) cm/sec and 5 (SD ⫽ 3) cm/sec for the spiral grafts and standard grafts,
SEPTEMBER 15–17, 2003
TCT ABSTRACTS/Poster
125L
P O S T E R A B S T R A C T S
MONDAY 9/15/03 9:00 –11:00
AM
and 2:00 – 4:00
respectively. These were significantly different (p ⫽ 0.02). Spiral graft implants presented with an average gross improvement of 11% while control implants presented at ⫺87%. Spiral graft implants presented with an average graft efficiency of ⫺8% while control implants presented at ⫺54%. Spiral graft implants presented with an average efficiency increase of 142% while the control implants presented at 87%. Fitting the preclinical data to different models of spiral flow was attempted. Conclusion: From this analysis, it was concluded that spiral grafts were more efficient than the control grafts at maintaining and improving downstream spiral flow characteristics.
PM
(Exhibit Hall B on the Lower Level)
re-PCI (n ⫽ 123) or coronary artery bypass graft (CABG) (n ⫽ 16). The long-term follow-up between patients treated with coronary bypass grafting or re-PCI was compared. Results: In patients treated with re-PCI, the cumulative survival rate was 98.3% and 92.7% at 1 and 5 years, respectively, compared with 87.5% in those initially treated with CABG (log-rank test: p ⫽
TCT-289 Intraoperative Coronary Angiography Leads to Higher Success Rates in Minimal Invasive and Off-Pump Coronary Artery Bypass Surgery. G.J. Friedrich, G. Laufer, N. Bonaros, O. Pachinger, J. Bonatti. Cardiology and Cardiosurgery Departments, Innsbruck University Hospital, Innsbruck, Austria.
P O S T E R A B S T R A C T S
Background: Minimal invasive coronary artery bypass (MIDCAB) and off-pump coronary artery bypass (OPCAB) surgery require immediate and long-term proof of graft patency to compete with established on-pump surgery or percutaneous revascularization procedures. Previous reports with postoperative angiography only describe immediate results and a high rate of surgical revision. Methods: We investigated 30 coronary bypass grafts in 22 patients (19 male, 3 female) in 15 OPCAB and 7 MIDCAB surgical procedures. Eligibility of patients was determined during cardiac surgery and cardiology conferences considering individual anatomic and clinical features. Transfemoral intraoperative coronary angiography was performed using an OEC mobile C-arm (General Electric Medical Systems, Waukesha, Wisconsin, USA and Toronto, Canada). Two orthogonal angiographic views were selected as standard projections. After 6 months, 15 of 22 patients underwent follow-up angiography. Results: Except for 2 venous grafts, all target arteries and grafts could be visualized by intraoperative angiography. In 91% (20 of 22 patients), severe spasm of native or graft vessel segments occurred; 19 of 20 responded to the application of intracoronary nitroglycerine. Three grafts were shown to be severely stenosed and required immediate surgical revision. No intraoperative angiography-related complications occurred. Follow-up angiography revealed patent grafts in all 15 patients; in one case, however, there was need for an angioplasty of a new significant stenotic lesion in a previously normal coronary artery. Vessel spasm during follow-up was less frequent (33%). Conclusion: Intraoperative coronary angiography, performed with intraluminal nitroglycerine, provides nonconfounding imaging of bypass grafting in MIDCAB and OPCAB surgery. This approach may improve the outcome of these innovative techniques.
TCT-290 Proximal Left Anterior Descending Coronary Artery In-Stent Restenosis: Should Coronary Bypass Grafting Necessarily Be Considered? R. Moreno, J. Pe´ ez, M.-J. Perez-Vizcayno, F. Alfonso, R. Hernandez, J. Escaned, M. Sabate, C. Ban˜ uelos, C. Macaya. Hospital Clinico San Carlos, Madrid, Spain. Background: Once a first interventional procedure has failed, patients with proximal left anterior descending coronary artery (LAD) in-stent restenosis (ISR) are frequently sent for surgical revascularization. We evaluated the long-term outcome of patients with proximal LAD ISR treated with repeat percutaneous coronary intervention (re-PCI), a new percutaneous procedure. Methods: We evaluated the long-term follow-up (3.3 years) of 249 patients with proximal LAD ISR (⬎50% diameter stenosis). Out of the total, 139 (56%) underwent a new revascularization procedure, either
126L
The American Journal of Cardiology姞
0.103; Breslow’s estimator: p ⫽ 0.023). The cumulative probability of being free from CABG in patients treated with re-PCI was 94.5% and 89.3% at 1 and 5 years, respectively, whereas freedom from a new CABG in patients initially treated with CABG was 93.7% both at 1 and 5 years (log-rank test: p ⫽ 0.8988; Breslow’s estimator: p ⫽ 0.8614). Conclusion: In patients with proximal LAD ISR requiring coronary revascularization, a new PCI was at least as safe as CABG at long-term follow-up. A new PCI in these patients was associated with a very good long-term outcome, with few patients needing CABG.
TCT-291 Cell-Patch Cardiomyoplasty and Omentopexy As an Adjunct of Coronary Artery Bypass. S. Taheri1, H. Ashraf1, H. Naughton1, A. Litwin1, Q. Zhao2. 1Kaleida Health Millard Fillmore Gates Circle Hospital, Buffalo, New York, USA; 2Shanghai Institute of Cardiovascular Diseases, Shanghai, China. Background: Loss of myocytes as a result of coronary artery occlusion is a major effect of the genesis of cardiac failure. Laboratory results of experimental cell-patch cardiomyoplasty and omentopexy show regeneration, viability, synchronous contraction, and migration of stem cells into infarcted myocardium. These encouraging results prompted us to use autologous cell-patch cardiomyoplasty and omentopexy during coronary bypass on 8 patients (New York Heart Association classes II, III) (6 male, 2 female). Average patient age was 65 years. Methods: During coronary artery bypass, the upper abdomen was opened via midline incision, which was extended to the umbilicus to expose and tailor the greater omentum to reach the mediastinum. Six pieces of rectus muscle measuring 11 ⫻ 11 ⫻ 2 cm were obtained, applied, and sutured to the dyskinetic ventricular wall, and reinforced by suturing the greater omentum over the muscle patches to the myocardium. Results: No deaths occurred among this group of patients. All had increased daily activities free from chest pain. Work capacity showed marked improvement with exercise testing. Regular daily activities were resumed 6 months after surgery. Individualized follow-up illustrated evidence of synchronous contraction of cell patches, higher ejection fraction, and improved perfusion with viability in grafted scar tissue, as proven by positron emission tomography (PET) and computed tomography angiography. Conclusion: Cell patch cardiomyoplasty and omentopexy seemed to limit infarction remodeling of the left ventricle, increase ejection fraction, and improve contraction of dyskinetic ventricular wall. It revealed viable regenerated muscle with increased perfusion, which was determined by PET scanning.
TCT-292 (withdrawn)
SEPTEMBER 15–17, 2003
TCT ABSTRACTS/Poster