PICVA

About 5% of patients annually have no acceptable therapeutic option because of diffuse coronary disease without a discrete target for angioplasty, stenting or surgical bypass. Retrograde perfusion of the myocardium via the venous system was successfully performed by cardiac surgeons before the widespread use of coronary artery bypass grafting and has been applied in "ungraftable" patients since. Percutaneous in situ venous arterialisation (PICVA) follows this surgical experience, using a series of unique catheter-based devices to arterialise isolated segments of coronary vein to provide retrograde perfusion of the ischaemic myocardium...

Diffuse coronary artery disease is frequently untreatable by coronary artery bypass or angioplasty. Open chest surgical arterialization of the coronary venous system was successfully performed before the widespread use of coronary artery bypass grafting and has been applied in ungraftable patients thereafter. Percutaneous in situ coronary venous arterialization (PICVA) follows this surgical experience, using a series of unique catheter-based devices to arterialize isolated segments of coronary vein, forcing retroperfusion of severely ischemic myocardium...

Catheter-based coronary bypass has evolved since its origin in 1995. We present a status update of one version of catheter-based bypass, percutaneous in situ coronary venous arterialization (PICVA), its successes and failures, and the many questions and challenges that remain. Initial clinical experience with PICVA demonstrated promising mitigation of angina in no-option patients, but was complicated by a relatively low procedural completion rate and a high incidence of MACE. A great deal was learned in these initial cases...