[Experimental application of synchronized coronary sinus retroperfusion (SCSR) and left heart bypass (LHB) for severe cardiogenic shock].
In order to evaluate the efficacies of concomitant use of left heart bypass (LHB) and synchronized coronary sinus retroperfusion (SCSR) for ischemic cardiogenic shock refractory to conventional mechanical circulatory assist such as intra-aortic balloon pumping (IABP), experimental comparison studies were made in swine. The acute myocardial infarction model was made by left anterior descending coronary artery (LAD) ligation method. LHB was performed by centrifugal pump (BioMedicus BP-80), supporting flows of half cardiac output. SCSR catheter was inserted into coronary sinus (CS) through external jugular vein. Then arterial blood was pumped from femoral artery to CS with flow of 60 to 70 ml/min which was synchronized to electrocardiogram (ECG). These animals were supported by only SCSR or LHB, and SCSR + LHB, comparing each cardiac performances, infarcted areas and coronary flow. Infarcted areas were evaluated by epicardial mapping ECG. Coronary blood flow and velocity were analyzed by electromagnetic flow meter and ultrasonic pulse doppler velocimeter respectively. In LHB group, coronary blood flow and velocity were increased because of elevation of mean aortic pressure. In addition, LVdp/dt, LVEDP were decreased, indicating left ventricular decompression. However, the infarcted area was slightly reduced. In contrast, it was remarkably reduced by SCSR, and cardiac function recovered gradually from cardiogenic shock. In SCSR + LHB group, the ischemic area was significantly reduced and their hearts completely recovered from cardiogenic shock, demonstrating the good supply and demand balance of myocardial oxygen. The systolic reverse LAD flow and velocity which was increased due to cardiogenic shock, was remarkably reduced. These results suggested this concomitant new application is suitable for recovering from cardiogenic shock due to AMI which is not able to apply antegrade coronary perfusion.
Second Department of Surgery, Nihon University School of Medicine, Tokyo, Japan.
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Hata
D000818:Animals; D018611:Heart Bypass, Left; D006439:Hemodynamics; D009203:Myocardial Infarction / Q000150:complications; D015425:Myocardial Reperfusion / Q000379:methods*; D012770:Shock, Cardiogenic / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D013552:Swine