Data to accompany, "Transcatheter Coronary Artery Bypass to Circumvent Iatrogenic Obstruction; The VECTOR (VEntriculo-Coronary Transcatheter Outward navigation and Re-entry) Procedure in Swine"

BackgroundCoronary artery obstruction is a rare but devastating complication of transcatheter aortic valve replacement (TAVR). Current techniques (transcatheter leaflet modification or ‘snorkel’ stenting) cannot prevent obstruction in all cases.MethodsWe created a transcatheter coronary artery bypass procedure, VECTOR (Ventriculo-coronary Transcatheter Outward Navigation and Re-entry), to bypass the proximal coronary artery with a covered stent graft. We tested feasibility of creating a neo-ostium, 10-15mm cephalad to the native, and bypassing the proximal coronary artery in swine. We established a proximal anastomosis using transcatheter electrosurgery to exit the aorta to the pericardium. The distal anastomosis was created using a guidewire to exit the proximal coronary artery and enter the pericardium. The points were connected and a covered stent graft implanted to bypass the proximal vessel. Coronary angiography and intravascular ultrasound (IVUS) were used to assess graft patency and expansion.ResultsVECTOR technique was developed in 11 and performed on the right coronary artery in 6 additional healthy swine. Proximal and distal anastomosis were successfully created and up to 3 (total length 40 [35-45]mm) covered stent grafts delivered to bypass the proximal vessel. There were no significant complications. All vessels had TIMI-III flow on completion.ConclusionsTranscatheter coronary artery bypass with VECTOR is feasible in swine and may offer an effective solution to circumvent iatrogenic coronary artery obstruction following TAVR when other transcatheter techniques are not possible.