HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map 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 Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Syeda, B. Articles by Mohl, W. Search for Related Content PubMed PubMed Citation Articles by Syeda, B. Articles by Mohl, W. Related Collections Myocardial protection

J Thorac Cardiovasc Surg 2004;127:1703-1712
© 2004 The American Association for Thoracic Surgery

Cardiopulmonary support and physiology

The salvage potential of coronary sinus interventions: Meta-analysis and pathophysiologic consequences

^a Department of Cardiology, Internal Medicine II, University of Vienna, Vienna, Austria
^b Department of Medical Computer Sciences, University of Vienna, Vienna, Austria
^c Department of Cardiothoracic Surgery, University of Vienna, Vienna, Austria

Received for publication November 20, 2003; revisions received December 22, 2003; accepted for publication January 28, 2004.

^* Address for reprints: Werner Mohl, MD, PhD, Department of Cardiothoracic Surgery, University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
werner.mohl{at}univie.ac.at

OBJECTIVES: Intermittent coronary sinus occlusion has been described to be effective in salvaging ischemic myocardium. This meta-analysis aims to review the efficacy of intermittent coronary sinus occlusion and intermittent coronary sinus occlusion in combination with retroperfusion of arterial blood as methods of myocardial salvage.

METHODS: A Medline search was performed to review the published literature on intermittent coronary sinus occlusion. The study inclusion criterion was a randomized, placebo-controlled trial with area of infarction (expressed as a percentage of the area at risk) as the primary end point.

RESULTS: Seven experimental trials comprising 125 test animals were found that analyzed the effects of intermittent coronary sinus occlusion on ischemic damage during coronary occlusion. A further 5 studies comprising 88 animals were designed to evaluate the effect of intermittent coronary sinus occlusion in combination with retroperfusion of arterial blood on the infarct size. A meta-analysis of the 7 studies analyzing the effect of intermittent coronary sinus occlusion revealed a significant reduction in infarct size of 29.3% in the treatment group compared with that in the placebo group (P < .001; 95% confidence interval, –40.9 to –17.7). A meta-analysis of the 5 trials analyzing the effect of intermittent coronary sinus occlusion in combination with retroperfusion revealed a reduction in infarct size of 39.4% in the treatment group compared with that in the placebo group (P < .001; 95% confidence interval, –48.9 to –29.9). Comparison between intermittent coronary sinus occlusion and intermittent coronary sinus occlusion in combination with retroperfusion of arterial blood showed no statistical difference (P = .19). An inverse relationship between achieved coronary sinus pressure increase per minute and infarct size could be found in the intermittent coronary sinus occlusion group (r = –0.92; P < .007), whereas in combination with retroperfusion, there was a negative correlation both between achieved coronary sinus pressure and the amount of the retroperfusate and myocardial salvage (r = –0.97; P < .004).

CONCLUSIONS: The use of intermittent coronary sinus occlusion and intermittent coronary sinus occlusion in combination with retroperfusion of arterial blood significantly decreases ischemic damage during coronary occlusions. Intermittent coronary sinus occlusion in combination with retroperfusion exhibits no significant profit in salvaging the ischemic myocardium in comparison with that provided by intermittent coronary sinus occlusion alone.

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]

				G. Weigel, I. Kajgana, H. Bergmeister, G. Riedl, H.-D. Glogar, M. Gyongyosi, S. Blasnig, G. Heinze, and W. Mohl Beck and back: A paradigm change in coronary sinus interventions--pulsatile stretch on intact coronary venous endothelium J. Thorac. Cardiovasc. Surg., June 1, 2007; 133(6): 1581 - 1587. [Abstract] [Full Text] [PDF]

				S. Banai, S. Ben Muvhar, K. H. Parikh, A. Medina, H. Sievert, A. Seth, J. Tsehori, Y. Paz, A. Sheinfeld, and G. Keren Coronary sinus reducer stent for the treatment of chronic refractory angina pectoris: a prospective, open-label, multicenter, safety feasibility first-in-man study. J. Am. Coll. Cardiol., May 1, 2007; 49(17): 1783 - 1789. [Abstract] [Full Text] [PDF]

				W. Mohl, I. Kajgana, H. Bergmeister, and F. Rattay Intermittent pressure elevation of the coronary venous system as a method to protect ischemic myocardium Interactive CardioVascular and Thoracic Surgery, February 1, 2005; 4(1): 66 - 69. [Abstract] [Full Text] [PDF]