Retrograde Coronary Sinus Perfusion for Myocardial Protection during Cardiopulmonary Bypass (original) (raw)
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The Journal of Thoracic and Cardiovascular Surgery, 1988
Effects of antegrade cardioplegic infusion with simultaneously controlled coronary sinus occlusion on preservation of regionally ischemic myocardium after acute coronary artery occlusion and reperfusion This study was conducted to assess the protective effects of antegrade infusion of cardioplegic solution with simultaneously controUed coronary sinus occlusion on regionally hichemic myocardium after acute coronary occlusion and reperfusion. Twelve sheep were subjected to 1 hour of occlusion of the distal left anterior descending coronary artery. Sheep in groupI (0 =6)were subjected only to infusion of potassium crystaUoid cardioplegic solution into the aortic root, whereas in group D (n = 6) a stitcb was snared around the proximal coronary sinus for its subsequent occlusion during antegrade infusions of cardioplegic solution. AU animals were placed on cardiopulmonary bypass. Five bWldred milliliters of cardioplegic solution at 4°to 8°C was administered in three divided doses during the total cross-clamp period of 30 minutes. The occlusion of the left anterior descending artery was then released, and the animals were weaned from bypass and studied for an additional 4 hours. Coronary sinus pressure, myocardial temperature, regional function assessed by pairs of ultrasonic crystals, global function assessed by rate of rise of left ventricular pressure and cardiac output, and the area at risk and area of necrosis were determined. The heart was excised at the end of the experiment and stained. Animals treated by the technique of antegrade infusion combined with coronary sinus occlusion bad more homogeneous myocardial cooling during cardioplegic infusic:m and better recovery of the first derivative of left ventricular pressure and regional segment shortening at 90 and 270 minutes of reperfusion than those treated with antegrade infusion alone (p < 0.01 and p < 0.05, respectively~The group treated by antegrade infusion of cardioplegic solution combined with coronary sinus occlusion bad an area of necrosis/area at risk ratio of 40.5% ± 1.2%; the antegrade infusion group, 58.3% ± 4.1 % (p < 0.01). These data suggest that antegrade infusion combined with coronary sinus occlusion may be an improved method of global and regional myocardial protection in the presence of an occluded coronary artery.
Journal of the American College of Cardiology, 1991
Positron emission tomography was used to image blood flow and metabolic tracers in risk zone myocardium after left anterior descending coronary artery occlusion during synchronized coronary venous retroperfusion. Six control and seven intervention open chest dogs had occlusion of the mid left anterior descending coronary artery. Synchronized retroperfusion commenced 25 min later. Flow tracers (rubidium-82 and nitrogen-13 ammonia) were injected retrogradely. Three hours after coronary occlusion, fluorine-18 (F-18) deoxyglucose uptake in the control and treatment groups was compared. At 200 min of occlusion, infarct size was assessed.
The Annals of Thoracic Surgery, 1970
he problem of myocardial preservation during cardiotomies is as old as open-heart surgery itself. At the advent of open-heart T surgery, various methods of cardioplegia were used to create a quiet operative field and at the same time to provide some degree of protection to the myocardium deprived of its blood supply [4-7, 16, 17, 19, 21, 23, 25, 26, 28, 31, 32, 34, 37, 511. The results of these operations were disappointing. A number of patients never got off the pump oxygenator, and the development of the ominous postoperative low-output syndrome was a rule rather than an exception. T h e causes of these unwanted results were undoubtedly complex: the operative technique was undeveloped, surgical experience scarce, valve prostheses inadequate, perfusion prolonged and unsatisfactory. Interestingly enough, in spite of the fact that these causes were well recognized, methods of myocardial protection-some of them undoubtedly unsatisfactory-received more than their share of the blame.
Salvage of ischemic myocardium by nonsynchronized retroperfusion in the pig
The Journal of Thoracic and Cardiovascular Surgery, 1992
Salvage of ischemic myocardium, with the aid of a nonsynchronized coronary sinus retroperfusion system, was studied in a pig infarct model. In anesthetized open chested animals, the left anterior descending coronary artery was occluded for 4 hours and then reperfused for 1 hour before the animals were killed. In the control group (n = 12) no therapy was used. In the experimental group (n = 13), nonsynchronized retrovenous coronary sinus perfusion was applied during the 4 hours of coronary artery occlusion. Therapy consisted of intermittent balloon occlusion of the coronary sinus (5-second inflation, 5-second deflation) with retroperfusion of arterial blood at 60 m1jmin during the inflation part of the cycle. Infarct size, expressed as a percentage of the area at risk (± standard deviation), was significantly smaller in the experimental group (41.5 % ± 15.0%) than in the control group (80.5% ± 6.1 %) (p < 0.001). Mean coronary sinus pressure (±standard deviation) was 51 ± 12 mm Hg in the experimental group but was not elevated in the control animals. We conclude that nonsynchronized retrovenous coronary sinus perfusion was able to significantly salvage ischemic myocardium in a model of minimal intercoronary collateral circulation.
Right ventricular protection with coronary sinus retrograde cardioplegia
Clinical Anatomy, 1994
Fifteen consecutive patients having open heart surgery using retrograde cardioplegia were studied to demonstrate that important venous collateralization exists between the coronary sinus (CS) and its left ventricular branches and the right ventricle (RV). The venous collateralization makes possible RV myocardial protection during retrograde cardioplegia. Right ventricular venous drainage principally occurs via anterior cardiac veins, which drain into the right atrium, and thebesian veins, which drain into both the RV and the atrium, generally without connection to the CS. Retrograde cardioplegia used during open heart surgery should, therefore, give inadequate myocardial protection to the RV. Two RV temperature probes used as markers for RV perfusion were monitored continuously during cardiac arrest. Systemic temperature while on cardiopulmonary bypass was 2YC, and the retrograde perfusate solution temperature was 4°C. Coronary sinus pressure during the bypass procedure was maintained between 20 torr and 50 torr. Mean temperatures at the two probe sites were 16.1"C and 14.5"C. We conclude that a complex network of venous collaterals between the coronary sinus and left ventricle and the right ventricle allow excellent myocardial protection during retrograde cardioplegia.
Prostaglandins Leukotrienes and Essential Fatty Acids, 1998
A total of 12 healthy mongrel dogs were subjected to the study. The left anterior descending artery was occluded. The occlusion was done for 15 min. At the end of this period, without removing the occlusion, the heart was retroperfused for 3 h. Then, occlusion w~s removed and repeffusion was supplied. Animals were divided into two equal groups. Six animals received iloprost and the other six control did not receive any additional treatment. In the iloprost group, the drug was administered into the coronary sinus.
The Journal of Thoracic and Cardiovascular Surgery, 1995
This study documents the gross flow characteristics and capillary distribution of cardioplegic solution delivered retrogradely with the coronary sinus open versus closed. Methods: Five explanted human hearts from transplant recipients were used as experimental models. Hearts served as their own controls and received two doses of warm blood cardioplegic solution, each containing colored microspheres. The first dose was delivered through a retroperfusion catheter with the coronary sinus open and the second dose was delivered with the sinus occluded. Capillary flow was measured at twelve ventricular sites and gross flow was measured by examining coronary sinus regurgitation, thebesian vein drainage, and aortic eifluent (nutrient flow). Results: Coronary sinus ostial occlusion allowed for a significant decrease in total cardioplegic flow (1.74 + 0.40 ml/gm versus 1.06 +-0.32 ml/gm; p < 0.05) to occur while maintaining an identical intracoronary sinus pressure. Ostial occlusion also resulted in an increase in the ratio of nutrient flow/total cardioplegic flow from 32.3% ---15.1% to 61.3% -4-7.9% (p < 0.05). A statistically significant improvement in capillary flow was found at the midventricular level in the posterior intraventricular septum and posterolateral right ventricular free wall. This improvement was also documented for the intraventricular septum and right ventricle at the level of the apex. Conclusion: Coronary sinus occlusion during retrograde cardioplegia significantly improves cardioplegic delivery to the right ventricle and posterior intraventricular septum. Furthermore, the technique affords a significant improve. ment in nutrient cardioplegic flow while reducing the overall volume of cardioplegic solution administered. (J THORAC CARDIOVASC SURG 1995;109:941-7)
Kosuyolu Kalp Dergisi, 2012
An operation on the beating heart was planned for a 60-year-old woman who applied to our clinic with aortic stenosis, three vessel coronary artery disease and poor left ventricular function. There are reports about beating heart valve surgery perfomed alone or combined with coronary artery bypass operations using continuous retrograde coronary sinus isothermic blood perfusion in patients with poor ventricle. We performed a coronary revascularization process for three-vessel disease on the pump beating heart and aortic valve replacement under cross-clamp using continuous retrograde coronary sinus isothermic blood perfusion in the same session. She was discharged on the sixth postoperative day after an uneventful recovery. She is well and active 24 months after the operation. Valve replacement using the retrograde coronary sinus isothermic blood perfusion technique due to its protective effect on the already borderline myocardial functions in patients with poor ventricles is a useful and clinically successful method.
The Annals of Thoracic Surgery, 1988
The efficacy of retrograde coronary sinus cardioplegia (RCSC) administered through the right atrium compared with aortic root cardioplegia (ARC) has not been examined critically in patients undergoing coronary artery bypass grafting (CABG). Twenty patients having elective CABG were randomized prospectively to receive cold blood ARC (Group I, 10 patients) or cold blood RCSC (Group 11, 10 patients). Patient demographics were similar in both groups. Ventricular function was assessed preoperatively by radionuclide ventriculography and postoperatively by simultaneous hemodynamic and radionuclide ventriculographic studies with volume loading. There was no change in ejection fraction (EF) (preoperative versus postoperative value) in Group I (50 f 6% versus 53 f 6%) but in group 11, at similar peak systolic pressure and similar left ventricular end-diastolic volume index (LVEDVI), LVEF improved significantly (49 f 6% versus 60 f 12%, p < 0.05). Postoperative ventricular function (stroke work index versus EDVI) for the left ventricle and right ventricle were similar in both groups. Evaluation of postoperative LV systolic function (end-systolic blood pressure versus end-systolic volume index) and diastolic function (pulmonary capillary wedge pressure versus EDVI) were also similar in both groups.