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Ann Thorac Surg 2001;71:402
© 2001 The Society of Thoracic Surgeons

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Correspondence

Advantages of pressure-controlled intermittent coronary sinus occlusion over left ventricle-powered coronary sinus retroperfusion

^a Department of Cardiothoracic Surgery, Boston Medical Center, Suite B404, 88 East Newton St, Boston, MA 02118-2393, USA

e-mail: harold.lazar{at}bmc.org

To the Editor

I read with interest the article by Martin and associates [1]. While I agree with the data presented, I feel that the left ventricle to coronary sinus shunt (LVCSS) offers less protection to the ischemic myocardium than pressure-controlled intermittent coronary sinus occlusion (PICSO).

In the PICSO technique, coronary sinus (CS) blood is shunted back through the coronary venous system to nourish ischemic myocardium by intermittent occlusion of the CS, using a preset cycle regulated with an external pump. CS occlusion is maintained for only 8 to 14 seconds, thus preventing trauma to the CS and myocardium due to venous distention. Using a model similar to that of Martin and colleagues, my coauthors and I were able to show that PICSO not only resulted in a similar decrease in the area of necrosis but also significantly improved regional wall motion and decreased tissue acidosis [2], resulting in better myocardial preservation than was achieved with LVCSS. It would appear that some degree of elevation of CS pressure is necessary to better preserve ischemic myocardium, as is evidenced by the fact that partial coronary sinus occlusion (PCSO) in addition to LVCSS further reduced infarct size in Dr Martin’s study.

Although an external pumping device is necessary for PICSO, this involves only a simple bellows-type pump. The inflation-deflation period is preset and requires no further manipulation, unlike the intraaortic balloon pump. The PICSO catheter can also be used to deliver retrograde CS cardioplegia and can be instituted percutaneously by insertion through the jugular vein. This avoids the need for a sternotomy and cannulation of the apex of the myocardium, as is the case with LVCSS, which may add to the morbidity of off-pump coronary artery bypass grafting (CABG). PICSO can also be instituted in community hospitals to provide retroperfusion during an MI. The same cannula could then be used during CABG to deliver retrograde cardioplegia. The ease of insertion, avoidance of manipulation and trauma to the left ventricle, more complete myocardial protection, and its versatility to not only support the myocardium but also preserve it with retrograde cardioplegia make PICSO a more superior method for myocardial support during off-pump CABG than is possible with LVCSS.

References

1. Martin J.S., Byrne J.G., Ghez O.Y., et al. LV-powered coronary sinus retroperfusion reduces infarct size in acutely ischemic pigs. Ann Thorac Surg 2000;69:84-89.[Abstract/Free Full Text]
2. Lazar H.L., Rajaii A., Roberts A.J. Reversal of reperfusion injury following ischemic arrest with pressure-controlled intermittent coronary sinus occlusion. J Thorac Cardiovasc Surg 1988;95:637-642.[Abstract]

This article has been cited by other articles:

				G. S. Kassab, J. A. Navia, K. March, and J. S. Choy Coronary venous retroperfusion: an old concept, a new approach J Appl Physiol, May 1, 2008; 104(5): 1266 - 1272. [Abstract] [Full Text] [PDF]

This Article Full Text (PDF) 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): Harold L. Lazar Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Lazar, H. L. Search for Related Content PubMed PubMed Citation Articles by Lazar, H. L. Related Collections Mediastinum Myocardial protection