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Continuous Coronary Sinus Perfusion Reverses Ongoing Myocardial Damage in Acute Ischemia
Author(s) -
Onorati Francesco,
Santarpino Giuseppe,
Cristodoro Lucia,
Scalas Cristian,
Costanzo Francesco Saverio,
Renzulli Attilio
Publication year - 2009
Publication title -
artificial organs
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 76
eISSN - 1525-1594
pISSN - 0160-564X
DOI - 10.1111/j.1525-1594.2009.00811.x
Subject(s) - medicine , cardiogenic shock , cardiology , cardiopulmonary bypass , coronary sinus , ejection fraction , myocardial infarction , perfusion , inotrope , artery , troponin i , anesthesia , heart failure
Acute cardiogenic shock or cardiac arrest (CS/CA) before cardiopulmonary bypass (CPB) installation are life‐threatening events in acute coronary syndromes. We evaluated whether continuous retrograde warm‐blood perfusion (CRWBP) before aortic cross‐clamping (ACC), with immediate CPB installation may improve hospital results in these dreadful events. Hospital outcome of 18 coronary artery bypass grafting (CABG) (Group A) with CS/CA before CPB, with immediate CPB installation and CRWBP, has been compared with 24 CABG (Group B) with CS/CA undergoing only immediate CPB installation. No differences have been detected in the mean time to establish CPB ( P = 0.655). Electrocardiography normalized in a significantly higher number of CRWBP ( P = 0.0001). Group B showed longer CPB (116.2 ± 21.2 min vs. 157.8 ± 32.4; P = 0.0001) and postoperative intra‐aortic balloon pumping time course (36.2 ± 5.9 h vs. 77.8 ± 13.2; P = 0.0001). CRWBP reduced postoperative acute myocardial infarction ( P = 0.004) and damage ( P = 0.033), death ( P = 0.026), and need for high inotropic support (0% vs. 37.5%; P = 0.003). Troponin I was significantly lower in Group A ( P = 0.013 from coronary sinus; P ≤ 0.0001 at 12, 24, and 48 h postoperatively; P = 0.008 at 72 h), never reaching values suggestive of acute myocardial infarction. Group A had also lower lactate release from aortic declamping to 48 h postoperatively ( P ≤ 0.0001). CRWBP improved postoperative left ventricular ejection fraction (EF) ( P = 0.017) and wall motion score index ( P = 0.041), whereas Group B showed a significant worsening of EF ( P = 0.0001) and wall motion score index ( P = 0.002). Patients in Group A had shorter intubation time ( P = 0.0001), intensive therapy unit (ITU) stay ( P = 0.001), and hospital stay ( P = 0.0001). CRWBP reverses myocardial damage in patients with CS/CA during acute coronary syndromes, adding a straightforward benefit to hospital survival.