Clinical evaluation of pressure-controlled intermittent coronary sinus occlusion: randomized trial during coronary artery surgery.
Pressure-controlled intermittent coronary sinus occlusion (PICSO) was evaluated in a randomized trial in 30 patients undergoing bypass surgery. PICSO was applied for one hour during early reperfusion. Myocardial function was determined from short-axis cross-sectional views of intraoperative two-dimensional echocardiography. Changes of sectional and segmental wall motion during extracorporeal circulation were analyzed. Although sectional wall motion did not change significantly, hypokinetic segments were preserved better in PICSO-treated patients than in controls (-1.3 +/- 2.4 versus -9.1 +/- 2.6 delta% fractional area change; p less than 0.04). Although not significant, the same trend was found for normal and severely hypokinetic segments. Cumulative enzyme release was related to coronary sinus occluded pressure (r = 0.94; p less than 0.006), indicating washout of metabolites during PICSO. Three months after operation, functional classification was similarly favorable in both groups. Long-term effects of PICSO cannot be predicted because PICSO was applied only during early reperfusion. We conclude that PICSO is a safe procedure and that its short-term beneficial effects on myocardial function suggest a preservation of myocardial viability.
D002404:Catheterization; D002986:Clinical Trials as Topic; D003250:Constriction; D001026:Coronary Artery Bypass; D003326:Coronary Circulation; D003331:Coronary Vessels; D004452:Echocardiography; D005112:Extracorporeal Circulation; D006324:Heart Arrest, Induced; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D008875:Middle Aged; D009200:Myocardial Contraction; D010477:Perfusion; D011312:Pressure; D011897:Random Allocation