Ihnken K, Morita K, Buckberg G D, Aharon A, Laks H, Beyersdorf F, Salerno T A
Division of Cardiothoracic Surgery, UCLA School of Medicine.
Thorac Cardiovasc Surg. 1994 Jun;42(3):141-7. doi: 10.1055/s-2007-1016476.
The existence of inhomogeneous distribution of coronary flow with antegrade or retrograde perfusion alone has led to alternating between these delivery routes to maximize their individual benefits. Concern over myocardial damage prevented the simultaneous application of antegrade and retrograde cardioplegic blood delivery. Based upon the predominance of retrograde drainage via Thebesian veins, and evidence that pressure-controlled intermittent coronary sinus occlusion during antegrade cardioplegic delivery enhances its distribution and protective properties, this study tests (a) the hypothesis that simultaneous aortic and coronary sinus perfusion is safe during aortic clamping, and (b) reports initial clinical application of this combined strategy in 174 patients. Five minipigs (25-30 kg) underwent 1 hr of aortic clamping with simultaneous aortic (antegrade) and coronary sinus (retrograde) perfusion at 200 ml/min with normal blood (37 degrees C) before and after 30 minutes of perfusion with either warm (37 degrees C) or cold (4 degrees C) blood cardioplegia (BCP). Furthermore, the combined strategy was used in 174 high-risk patients (NYHA class III-IV) at 3 university hospitals to perform myocardial protection during CABG or valve replacement, or a combination of both. Included were 16 patients in cardiogenic shock and 24 undergoing reoperation. In both the clinical and the experimental studies the coronary sinus pressure was always < 40 mmHg in beating or arrested hearts.
Compared to control values (81.4 +/- 0.4% tissue water content), no right-ventricular (80.8 +/- 0.8%) or left-ventricular (79.5 +/- 0.3%) edema developed, no lactate was produced (control: -1.0 +/- 0.5 mg/100 g/min, empty beating: -0.64 +/- 5, and BCP arrest: -8.6 +/- 6.6).(ABSTRACT TRUNCATED AT 250 WORDS)
仅采用顺行或逆行灌注时冠状动脉血流分布不均的情况，促使人们在这两种灌注途径之间交替使用，以最大化各自的益处。对心肌损伤的担忧使得顺行和逆行心脏停搏液灌注不能同时进行。基于经心最小静脉逆行引流的优势，以及在顺行心脏停搏液灌注期间进行压力控制的间歇性冠状窦闭塞可增强其分布和保护特性的证据，本研究检验了：（a）在主动脉阻断期间同时进行主动脉和冠状窦灌注是安全的这一假设；（b）报告了该联合策略在174例患者中的初步临床应用情况。5只小型猪（25 - 30千克）在分别用温血（37℃）或冷血（4℃）心脏停搏液（BCP）灌注30分钟之前和之后，以200毫升/分钟的速度同时进行主动脉（顺行）和冠状窦（逆行）灌注，持续1小时的主动脉阻断，灌注的是正常血液（37℃）。此外，在3家大学医院，该联合策略被用于174例高危患者（纽约心脏协会心功能分级III - IV级），以在冠状动脉旁路移植术（CABG）或瓣膜置换术或两者联合手术期间进行心肌保护。其中包括16例心源性休克患者和24例再次手术患者。在临床和实验研究中，跳动或停搏心脏的冠状窦压力始终<40 mmHg。
与对照值（组织含水量81.4±0.4%）相比，右心室（80.8±0.8%）或左心室（79.5±0.3%）均未出现水肿，未产生乳酸（对照：-1.0±0.5毫克/100克/分钟，空跳：-0.64±5，BCP停搏：-8.6±6.6）。（摘要截断于250字）
