The safety of simultaneous arterial and coronary sinus perfusion: Experimental background and initial clinical results

K. Ihnken, K. Morita, G. D. Buckberg, A. Aharon, H. Laks, A. L. Panos, D. C. Drinkwater, R. Chugh, D. Del Rizzo, Tomas Salerno

Research output: Contribution to journalArticle

44 Citations (Scopus)

Abstract

Concern over myocardial damage from simultaneous arterial (antegrade) and coronary sinus (retrograde) perfusion has led to alternating between these delivery routes to maximize their individual benefits. Based upon predominant retrograde drainage via Thebesian veins, this study: (1) confirms experimentally the safety of simultaneous arterial and coronary sinus perfusion; and (2) reports initial clinical application of this combined strategy in 155 consecutive patients. Experimental: Five mini-pigs (25 to 30 kg) underwent 1 hour of aortic clamping with simultaneous aortic and coronary sinus perfusion at 200 mL/min with normal blood (37°C) before and after 30 minutes of perfusion with either warm (37°C) or cold (4°C) blood cardioplegia. Coronary sinus pressure was always less than 30 mmHg. There was no right or left ventricular edema, lactate production, or lipid peroxidation as transmyocardial and myocardial conjugated dienes were unaltered, and postbypass recovered left ventricular end-systolic elastance (conductance catheter) and preload recruitable stroke work index 101% ± 3% and 109% ± 90%, respectively. Clinical: Simultaneous arterial/coronary sinus perfusion was used in 155 consecutive high risk patients (New York Heart Association Class III to IV) undergoing isolated coronary artery bypass grafting (CABG) (n = 109) and CABG + valve replacement/repair or aneurysm (n = 46). Included were 16 patients in cardiogenic shock and 24 undergoing reoperation. Mean aortic clamping time averaged 90 ± 4 minutes (range 30 to 207), with 3.5 ± 0.1 grafts per patient; all anastomoses were performed with the aorta clamped. Cold intermittent blood cardioplegia was used for distal anastomoses and valve implantation/repair in 123 patients, and warm continuous blood cardioplegia was used in 32 patients. Following a warm cardioplegic reperfusate, all patients received warm noncardioplegic blood perfusion simultaneously via grafts and coronary sinus. Coronary sinus pressure was always less than 40 mmHg. Of 18 patients requiring postoperative mechanical circulatory support (IABP), 16 had IABP placed preoperatively for cardiogenic shock. There were three postoperative myocardial infarctions (2%), and six patients died (3.9% mortality). Conclusion: These experimental and clinical findings overcome perceived concerns about myocardial damage from simultaneous arterial and coronary sinus perfusion, and suggest this approach may add to the armamentarium of cardioprotective strategies.

Original languageEnglish
Pages (from-to)15-25
Number of pages11
JournalJournal of Cardiac Surgery
Volume9
Issue number1
StatePublished - Jan 1 1994
Externally publishedYes

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Coronary Sinus
Perfusion
Safety
Induced Heart Arrest
Cardiogenic Shock
Constriction
Coronary Artery Bypass
Transplants
Pressure
Sinus of Valsalva
Reoperation
Lipid Peroxidation
Aneurysm
Aorta
Drainage
Veins
Lactic Acid
Edema
Swine
Catheters

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

The safety of simultaneous arterial and coronary sinus perfusion : Experimental background and initial clinical results. / Ihnken, K.; Morita, K.; Buckberg, G. D.; Aharon, A.; Laks, H.; Panos, A. L.; Drinkwater, D. C.; Chugh, R.; Del Rizzo, D.; Salerno, Tomas.

In: Journal of Cardiac Surgery, Vol. 9, No. 1, 01.01.1994, p. 15-25.

Research output: Contribution to journalArticle

Ihnken, K, Morita, K, Buckberg, GD, Aharon, A, Laks, H, Panos, AL, Drinkwater, DC, Chugh, R, Del Rizzo, D & Salerno, T 1994, 'The safety of simultaneous arterial and coronary sinus perfusion: Experimental background and initial clinical results', Journal of Cardiac Surgery, vol. 9, no. 1, pp. 15-25.
Ihnken, K. ; Morita, K. ; Buckberg, G. D. ; Aharon, A. ; Laks, H. ; Panos, A. L. ; Drinkwater, D. C. ; Chugh, R. ; Del Rizzo, D. ; Salerno, Tomas. / The safety of simultaneous arterial and coronary sinus perfusion : Experimental background and initial clinical results. In: Journal of Cardiac Surgery. 1994 ; Vol. 9, No. 1. pp. 15-25.
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AU - Laks, H.

AU - Panos, A. L.

AU - Drinkwater, D. C.

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AU - Salerno, Tomas

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