HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Oguz Tasdemir Kemal Bayazit Gabriel S. Aldea Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Katircioglu, S. F. Articles by Aldea, G. S. Search for Related Content PubMed PubMed Citation Articles by Katircioglu, S. F. Articles by Aldea, G. S.

Ann Thorac Surg 1997;63:1210-1211
© 1997 The Society of Thoracic Surgeons

---

Correspondence

Coronary Sinus Retroperfusion With a Simple Method

S. Fehmi Katirciolu, MD, Ouz Tademir, MD, Kemal Bayazit, MD

Cardiovascular Surgery Clinic, Türkiye Yüksek htisas Hospital, 06100 Sihhiye/Ankara, Turkey

To the Editor:

We have read Aldea and associates' article [1] about simplified coronary sinus retroperfusion with great interest. They documented that simplified use of coronary sinus retroperfusion is as effective as the known retroperfusion devices. In this letter, we would like to document our initial experimental experience.

It is well known that retroperfusion is an alternative method to perfuse the acutely ischemic myocardium until the establishment of blood flow is achieved. Clinical and experimental studies demonstrated that retroperfusion increases the contractile activity of the ischemic muscle, reduces the infarct size, and improves myocardial energy metabolism. The new catheters make access to the coronary sinus easier and safer. However, the complexity of this system is one of the major factors limiting the its widespread use. It is unclear to us if any simple retroperfusion device is as effective as the previously developed ones. Aldea and associates showed that simple retroperfusion reduces the infarct size.

We also previously investigated the efficacy of simple retroperfusion. In our experimental research [2], acute myocardial ischemia was developed by occluding the left anterior descending artery. To treat this pathophysiology we used an intraaortic balloon and a catheter connecting the aorta to the coronary sinus for sinus retroperfusion. This connection gave us blood flow of about 58 mL and 23 mm Hg maximal pressure in the coronary sinus. One group was treated with intraaortic balloon only and the other group was treated with intraaortic balloon pumping with intermittent coronary sinus retroperfusion. At the end of this study, we observed that hemodynamic recovery was better in the balloon plus retroperfusion group than the intraaortic balloon alone group based on on the cardiac output and pressure data. We predicted that our retroperfusion system provides metabolic support to the myocardium. We are currently investigating the metabolic effects of our retroperfusion system on myocardium.

We believe that simplified retroperfusion is an effective method to treat the acutely ischemic myocardium, but the combination of retroperfusion and intraaortic balloon pumping further improves myocardial recovery.

References

1. Aldea GS, Zhang X, Rivers S, Shemin RJ. Salvage of ischemic myocardium with simplified and even delayed coronary sinus retroperfusion. Ann Thorac Surg 1996;62:9–15.[Abstract/Free Full Text]
2. Katirciolu SF, Küçükaksu DS, Gökçe P, Özgencil E, Tademir O, Bayazit K. Coronary sinus retroperfusion combined with intraaortic balloon pumping to perfuse the acutely ischemic myocardium. Thorac Cardiovasc Surg 1994;42:330–2.[Medline]

Reply

Department of Cardiothoracic Surgery, Boston University Medical Center, 88 E Newton St, B402, Boston, Ma 02118-2393

To the Editor:

My colleagues and I thank Dr Katirciolu and colleagues for their comments on our recently published article, which describes a simplified coronary sinus (CS) retroperfusion technique [1]. We completely agree with their conclusions that CS retroperfusion is an effective way of minimizing infarct size and that despite the availability of several such techniques, wide application of retroperfusion systems has been limited by concerns over their complexity and safety. Doctor Katirciolu and colleagues also reference their experience with an acutely ischemic model in which CS retroperfusion was accomplished by using arterial blood from an intraaortic balloon pump port, delivered at 58 mL/min in a passive fashion, and resulted in better hemodynamic recovery of the ischemic myocardium when compared with intraaortic balloon counterpulsation alone [2]. This is an interesting technique, which demonstrates the additive clinical benefits of intraaortic balloon pumping and CS retroperfusion. Our work, however, suggests that myocardial salvage with CS retroperfusion can be further simplified by continuous (rather than synchronized) delivery at even lower flows (7 mL/min) with minimal elevation of CS pressures and therefore a decreased risk of CS injury. Furthermore, equivalent myocardial salvage (>40% of ischemic area) was accomplished with arterial, venous, and crystalloid retroperfusate solutions even when CS retroperfusion was delayed by more than 60 minutes. This experience suggests that an arterial blood source or puncture is unnecessary. The concepts of controlled reperfusion with avoidance of potentially injurious hyperoxia, avoidance of high reperfusion pressures, replenishment and restoration of effective oxidative metabolism, membrane stabilization, administration of oxygen free radical scavengers, decreasing regional edema, reversal of acidosis, and limitation of intracellular calcium influx, among many other elements designed to limit the reperfusion injury, were very well delineated by Allen and associates [3]. These principles, which are now firmly established in the practice of intraoperative myocardial protection, should be liberally applied to preoperative interventions because most myocardial damage occurs before initiation of cardiopulmonary bypass; these principles should be applied as well as to the protection of acutely ischemic myocardium even when a surgical intervention is not contemplated. Both cardiologist and surgeons need to expand their scope of therapy to develop new safe and effective strategies to maximize myocardial salvage before any revascularization of acutely ischemic myocardium.

References

1. Aldea GS, Zhang X, Rivers S, Shemin RJ. Salvage of ischemic myocardium with simplified and even delayed coronary sinus retroperfusion. Ann Thorac Surg 1996;62:9–15.
2. Katiriolu SF, Küçükaksu DS, Gökçe P, Özgencil E, Tademir O, Bayazit K. Coronary sinus retroperfusion combined with intraaortic balloon pumping to perfuse the acutely ischemic myocardium. Thorac Cardiovasc Surg 1994;42:330–2.
3. Allen BS, Okamoto F, Buckberg GD, et al. Studies on controlled reperfusion after ischemia. XV. Functional recovery after 6 hours of regional ischemia by careful control of condition of reperfusion and composition of retroperfusate. J Thorac Cardiovasc Surg 1986;92:621–35.[Abstract]

This article has been cited by other articles:

				S F. Katircioglu, A T. Ulus, and A. Aksoyek Coronary Sinus Retroperfusion With a Simple Method Asian Cardiovasc Thorac Ann, September 1, 2001; 9(3): 252 - 252. [Full Text] [PDF]

This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Oguz Tasdemir Kemal Bayazit Gabriel S. Aldea Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Katircioglu, S. F. Articles by Aldea, G. S. Search for Related Content PubMed PubMed Citation Articles by Katircioglu, S. F. Articles by Aldea, G. S.