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Ann Thorac Surg 1996;62:15
© 1996 The Society of Thoracic Surgeons
DR RICHARD M. ENGELMAN (Springfield, MA): In terms of the retroperfusion, it seemed to me you indicated that the crystalloid had an effect equal to that of blood; is that correct?
DR ALDEA: That is correct.
DR ENGELMAN: In essence then, how do you foresee it as being oxygenated material that is effecting an improvement here, because the crystalloid clearly would not be as oxygenated as blood?
DR ALDEA: That is correct. We know from studies both with PICSO and specifically with synchronized retroperfusion that neither technique provides enough nutritive flow to salvage the myocardium. In the best of circumstances only 10% to 60% of myocardial blood is established with either technique. The PICSO technique itself works by displacing very desaturated coronary sinus blood. We know from other measurements that we have made in this model that there is actual delivery of retroperfusate to the myocardium, and we believe that there is actually both a displacement of coronary sinus blood into the ischemic area and, in addition, actual retroperfusate delivery. So I think it underscores the point that very small amounts of blood could be delivered to an ischemic area and still result in some significant myocardial salvage.
DR HENRY M. SPOTNITZ (New York, NY): I enjoyed your paper very much. I guess the obvious question is, what happens if you just partially occlude the coronary sinus? Have you done that experiment, and does it have a similar effect?
DR ALDEA: We have not done that experiment, and I would not speculate on the outcome at this point.
DR GEORGE C. KAISER (St. Louis, MO): I was intrigued by this. Could it be that instead of delivering oxygenated material or solution to the myocardium you are washing away some of the metabolites, which could be further injuring the cell at the time? If that is the case, any kind of solution might accomplish that. Have you looked into that?
DR ALDEA: Thank you. That is an excellent question, and I think that is exactly what we are about to investigate next. The presumed mechanism of how PICSO works is indeed to enhance washout of toxic metabolites. An alternative to that mechanism would be some modification of endothelial integrity, neutrophil adhesion, or decreased neutrophil plugging, which also was suggested. So in the next set of experiments we plan to look at neutrophil activity and at endothelial reactivity as possible explanations for these findings.
Related Article
Ann. Thorac. Surg. 1996 62: 9-15.
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