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J Thorac Cardiovasc Surg 2004;127:1018-1025
© 2004 The American Association for Thoracic Surgery

Cardiopulmonary support and physiology

Reduction of systolic and diastolic dysfunction by retrograde coronary sinus perfusion during off-pump coronary surgery

^a Department of Surgery, Division of Cardiothoracic Surgery, University of California, Los Angeles School of Medicine, Los Angeles, Calif, USA

Read at the Eighty-third Annual Meeting of The American Association for Thoracic Surgery, Boston, Mass, May 4-7, 2003.

Received for publication May 2, 2003; revisions received August 27, 2003; accepted for publication September 8, 2003.

^* Address for reprints: Gerald D. Buckberg, MD, Division of Cardiothoracic Surgery, 62-258 Center for the Health Sciences, Los Angeles, CA 90095-1701, USA
gbuckberg{at}mednet.ucla.edu

OBJECTIVES: We evaluated the protective effects of retrograde coronary sinus perfusion to offset potential systolic and diastolic dysfunction (myocardial stunning) after temporary regional ischemia needed for off-pump coronary artery bypass grafting.

METHODS: Twenty Yorkshire-Duroc pigs (31.8 ± 3.9 kg) underwent 15 minutes of mid-left anterior descending coronary artery ischemia in the beating heart. In 8 pigs, no protective measures were used. In 12 pigs, an aorta-coronary sinus shunt (with conventional cannulas) allowed retrograde perfusion during temporary ischemia; in 6 of these pigs, no leakage to the right atrium was ensured. Regional endocardial contraction was measured with sonomicrometer crystals. Systolic dysfunction (impaired regional shortening), diastolic dysfunction (contraction extending into early diastole), and coronary sinus nitric oxide and endothelin-1 levels were recorded.

RESULTS: Before ischemia, contraction did not extend into the diastolic interval. During ischemia, paradoxic bulging occurred in all hearts except in the occlusive coronary sinus shunt group (16% ± 6% of baseline, P < .01). Sixty minutes after ischemia, systolic segment shortening recovered 36% ± 24% without retrograde perfusion versus 56% ± 20% and 61% ± 14% with coronary sinus shunting (P < .05). Diastolic dysfunction (as percentage of diastolic time in contraction) was 38% ± 16% in the nontreated group versus 22% ± 22% and 9% ± 9% (P < .05) after shunting and occlusive shunting, respectively. This correlated with a left ventricular end-diastolic pressure increase of 4 mm Hg in the ischemic group versus no change in the retrograde perfusion groups. Nitric oxide decreased 15% without shunting and increased 8% after occlusive coronary sinus shunting (P < .05).

CONCLUSIONS: Retrograde coronary sinus perfusion during simulated off-pump coronary revascularization diminishes systolic and diastolic dysfunction. An aortic-coronary sinus shunt is a rapid, recognized approach that can improve myocardial muscle and endothelial safety during off-pump coronary artery bypass grafting.

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				H. S. Bedi Clinical efficacy of retrograde coronary sinus perfusion in off-pump surgery J. Thorac. Cardiovasc. Surg., February 1, 2005; 129(2): 476 - 477. [Full Text] [PDF]