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Ann Thorac Surg 1988;46:192-201
© 1988 The Society of Thoracic Surgeons

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Articles

Clinical Evaluation of Pressure-Controlled Intermittent Coronary Sinus Occlusion: Randomized Trial During Coronary Artery Surgery

From the Second Surgical Clinic, University of Vienna, Vienna, Austria

Accepted for publication February 3, 1988.

^* Address reprint requests to Dr. Mohl, Second Surgical Clinic, University of Vienna, Spitalgasse 23, A-1090 Vienna, Austria.

Pressure-controlled intermittent coronary sinus occlusion (PICSO) was evaluated in a randomized trial in 30 patients undergoing bypass surgery. PICSO was applied for one hour during early reperfusion. Myocardial function was determined from short-axis cross-sectional views of intraoperative two-dimensional echocardiography. Changes of sectional and segmental wall motion during extracorporeal circulation were analyzed. Although sectional wall motion did not change significantly, hypokinetic segments were preserved better in PICSO-treated patients than in controls (–1.3 ± 2.4 versus –9.1 ± 2.6% fractional area change; p < 0.04). Although not significant, the same trend was found for normal and severely hypokinetic segments. Cumulative enzyme release was related to coronary sinus occluded pressure (r = 0.94; p < 0.006), indicating washout of metabolites during PICSO. Three months after operation, functional classification was similarly favorable in both groups. Long-term effects of PICSO cannot be predicted because PICSO was applied only during early reperfusion. We conclude that PICSO is a safe procedure and that its short-term beneficial effects on myocardial function suggest a preservation of myocardial viability.

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