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J Thorac Cardiovasc Surg 2004;127:1549-1552
© 2004 The American Association for Thoracic Surgery

Editorial

Coronary sinus retroperfusion: Can forward progress still be achieved by using a backward technique?

^a Department of Cardiothoracic Surgery, the Boston University School of Medicine, and the Boston Medical Center, Boston, Mass, USA

Received for publication February 11, 2004; revisions received February 13, 2004; accepted for publication February 25, 2004.

^* Address for reprints: Harold L. Lazar, MD, Department of Cardiothoracic Surgery, Boston Medical Center, 88 East Newton St, Boston, MA 02118, USA
harold.lazar@bmc.org

The first 300 words of the full text of this article appear below.

See related article on page 1703.

 

In this month's edition of the Journal, Syeda and colleagues¹ report the results of a meta-analysis performed on randomized experimental trials to assess the efficacy of coronary sinus retroperfusion by using intermittent coronary sinus occlusion (ICSO) and synchronized retroperfusion (SRP) to salvage acutely ischemic myocardium. In the ICSO technique a balloon-tipped catheter is positioned just beyond the orifice of the coronary sinus, similar to the placement of a retrograde coronary sinus cardioplegia catheter. The catheter is connected to a pneumatic pump that automatically inflates and deflates the balloon according to a preset cycle. A cycle of 10 seconds of inflation and 4 seconds of deflation was found to be the optimal period to limit the increase of pressure in the coronary sinus. This allows for sufficient drainage of coronary venous blood and avoids the complications of hemorrhage, edema, thrombosis, and arrhythmias observed with prolonged increase of coronary sinus pressure. This ability to limit peak coronary sinus pressure led to the term pressure-controlled intermittent coronary sinus occlusion (PICSO). The sudden occlusion of a coronary artery results in a significant decrease in coronary sinus pressure. By increasing coronary sinus pressure, PICSO redistributes coronary venous flow to jeopardized areas of the myocardium distal to an arterial occlusion. The intermittent inflation-deflation cycle also enhances the washout of toxic metabolites that form during periods of coronary occlusion and ischemia.

In contrast to PICSO, which displaces existing coronary venous blood, SRP actively pumps arterial blood retrograde through the coronary sinus. In this technique a catheter is placed in the femoral artery, and arterial blood is withdrawn and pumped into the coronary venous system during diastole through a catheter positioned into the coronary sinus. The meta-analysis by Syeda and colleagues¹ of 7 experimental studies in which PICSO was performed . . . [Full Text of this Article]

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