Asian Cardiovasc Thorac Ann 2001;9:252
© 2001 Asia Publishing EXchange Pte Ltd
Coronary Sinus Retroperfusion With a Simple Method
S Fehmi Katircio
lu, MD,
A Tulga Ulus, MD,
Aysen Aksoyek, MD
Department of Cardiovascular Surgery
Türkiye Yüksek Ihtisas Hospital
Sihhiye, Ankara 06100, Turkey
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We read the articles by Sajja and colleagues1 and Güden and colleagues2 with great interest. As these authors pointed out, perfusion of the heart via the coronary veins improves myocardial hemodynamic and biochemical function. This situation is especially important in some specific conditions: acute coronary occlusion, and severe left main stenosis. In patients with severe left main stenosis, there is a high risk of myocardial ischemia occurring after placing the bypass. The time between the onset of cardio-pulmonary bypass and the application of the crossclamp may aggravate myocardial ischemia, thus reducing the efficiency of myocardial protection. To circumvent these adverse conditions, retroperfusion via the coronary sinus with a simple system may be a reasonable way of decreasing the degree of myocardial ischemia.
Initially, we assumed that aorta-coronary sinus perfusion could nourish the myocardium at risk, without using an extra device.3 Previously, this technique had used a sophisticated system that increased the cost of the treatment. Earlier studies had shown that conventional retroperfusion increases the contractile force of ischemic tissue, reduces infarct size, and improves energy metabo-lism and myocardial oxygenation, which leads to a reduction of ST-segment elevation. These effects may be explained by the fact that a rise in coronary venous pressure allows arterial blood to enter the microcirculation of the heart retrogradely, while waste products can also be removed. These factors significantly limit the adverse effects of ischemic and reperfusion injury.
Our studies documented that a simple coronary venous perfusion procedure inhibited the release of toxic mediators such as malondialdehyde acid and protein thiol, and protected myocardial metabolic function. We also confirmed some of these findings in the clinical setting. Certain additional factors may increase the efficiency of this method.4–8 As a result of these findings, we recommend this technique especially in patients with a severe left anterior descending coronary artery lesion and poorly developed collateral circulation, critical left main stenosis, or acute coronary artery occlusion during surgery.
REFERENCES
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Sajja LR, Farooqi A, Yarlagadda RB, Mastan SS, Pothineni RB. Retrograde coronary sinus perfusion for severe left main stenosis. Asian Cardiovasc Thorac Ann 2000;8: 290–1.[Abstract/Free Full Text]
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Güden M, Akpinar B, Bayindir O, Sagbas E, Sarisoglu I, Demiroglu C. Early myocardial resuscitation via coronary sinus retroperfusion. Asian Cardiovasc Thorac Ann 2000; 8:330–2.[Abstract/Free Full Text]
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Katircioglu SF, Tasdemir O, Bayazit K. Coronary sinus retroperfusion with a simple method. Ann Thorac Surg 1997;63:1210–1.[Free Full Text]
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Katircioglu SF, Küçükaksu S, Gökçe P, Özgencil E, Tasdemir O, Bayazit K. Coronary sinus retroperfusion combined with intra-aortic balloon pumping to perfuse the acutely ischemic myocardium. Thorac Cardiovasc Surg 1994;42:330–2.[Medline]
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Katircioglu SF, Yücel D, Saritas Z, Yamak B, Elsheikh AE, Tasdemir O. Simplified retroperfusion system preserves the myocardial function during acute coronary artery occlusion. Thorac Cardiovasc Surgeon 1998;46:1–6.[Medline]
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Katircioglu SF, Ulus AT, Iscan Z, Yamak B, Saritas Z, Birincioglu L. Preservation of myocardial metabolism in acute coronary artery occlusions with retrograde coronary sinus perfusion and iloprost. Prostaglandins Leukot Essent Fatty Acids 1998;59:169–74.[Medline]
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Uzunonat G, Emir M, Yamak B, Ulus AT, Ulas M, Uncu H, et al. Coronary sinus retroperfusion during acute experimental coronary artery occlusion. J Cardiovasc Surg 1999;40:197–201.[Medline]
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Katircioglu SF, Iscan Z, Ulus AT, Saritas Z. Myocardial preservation in acute coronary artery occlusion with coronary sinus retroperfusion and carnitine. J Cardiovasc Surg 2000;41:45–50.[Medline]
