Menasche P, Piwnica A
Department of Cardiovascular Surgery, Hôpital Lariboisière, Paris, France.
J Am Coll Cardiol. 1991 Aug;18(2):628-36. doi: 10.1016/0735-1097(91)90623-h.
Retrograde coronary sinus perfusion has recently reemerged as an attractive means of delivering cardioplegic solutions during open heart procedures. In patients undergoing aortic valve or aortic root surgery, there is no evidence that coronary sinus cardioplegia results in a better myocardial protection than that achieved with the use of standard methods of anterograde cardioplegia delivery. However, the retrograde approach provides distinct technical advantages that might favor its use as an alternative to direct coronary ostial cannulation. In select subgroups of patients undergoing coronary bypass procedures, there is a growing body of evidence that the coronary sinus route may be more effective than the anterograde route because of its superior capacity to ensure homogeneous distribution of cooling and cardioplegia in myocardial areas supplied occluded arteries. The well established safety of coronary sinus cardioplegia in the clinical setting further justifies its inclusion among techniques for ensuring adequate myocardial preservation during surgically induced ischemic arrest.
逆行冠状静脉窦灌注最近再次成为心脏直视手术期间输送心脏停搏液的一种有吸引力的方法。在接受主动脉瓣或主动脉根部手术的患者中，没有证据表明冠状静脉窦心脏停搏比使用标准的顺行心脏停搏输送方法能带来更好的心肌保护。然而，逆行方法具有明显的技术优势，这可能有利于将其用作直接冠状动脉口插管的替代方法。在接受冠状动脉搭桥手术的特定亚组患者中，越来越多的证据表明，冠状静脉窦途径可能比顺行途径更有效，因为它在确保闭塞动脉供血的心肌区域均匀分布冷却和心脏停搏液方面具有更强的能力。冠状静脉窦心脏停搏在临床环境中已确立的安全性进一步证明将其纳入确保手术诱导的缺血性停搏期间充分心肌保护的技术是合理的。
