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

Manuel Castellá, Gerald D. Buckberg, Y. Joseph Woo, Nilas Young, Jakob Vinten-Johansen

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

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-I levels were recorded. Results: Before ischemia, contraction did not extend into the diastolic interval. Dnring 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.

Original languageEnglish (US)
Pages (from-to)1018-1025
Number of pages8
JournalJournal of Thoracic and Cardiovascular Surgery
Volume127
Issue number4
DOIs
StatePublished - Apr 2004

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Infusion Pumps
Coronary Sinus
Ischemia
Perfusion
Swine
Off-Pump Coronary Artery Bypass
Coronary Artery Bypass
Nitric Oxide
Myocardial Stunning
Sinus of Valsalva
Diastole
Endothelins
Heart Atria
Aorta
Coronary Vessels
Blood Pressure
Safety
Muscles

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Reduction of systolic and diastolic dysfunction by retrograde coronary sinus perfusion during off-pump coronary surgery. / Castellá, Manuel; Buckberg, Gerald D.; Woo, Y. Joseph; Young, Nilas; Vinten-Johansen, Jakob.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 127, No. 4, 04.2004, p. 1018-1025.

Research output: Contribution to journalArticle

Castellá, Manuel ; Buckberg, Gerald D. ; Woo, Y. Joseph ; Young, Nilas ; Vinten-Johansen, Jakob. / Reduction of systolic and diastolic dysfunction by retrograde coronary sinus perfusion during off-pump coronary surgery. In: Journal of Thoracic and Cardiovascular Surgery. 2004 ; Vol. 127, No. 4. pp. 1018-1025.
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abstract = "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-I levels were recorded. Results: Before ischemia, contraction did not extend into the diastolic interval. Dnring 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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T1 - Reduction of systolic and diastolic dysfunction by retrograde coronary sinus perfusion during off-pump coronary surgery

AU - Castellá, Manuel

AU - Buckberg, Gerald D.

AU - Woo, Y. Joseph

AU - Young, Nilas

AU - Vinten-Johansen, Jakob

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N2 - 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-I levels were recorded. Results: Before ischemia, contraction did not extend into the diastolic interval. Dnring 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.

AB - 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-I levels were recorded. Results: Before ischemia, contraction did not extend into the diastolic interval. Dnring 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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