Reconsidering the back door approach by targeting the coronary sinus in ischaemic heart disease.
Coronary sinus interventions (CSI) are a class of invasive techniques (surgical and percutaneous) originally proposed in the first half of the 20th century, aiming to treat ischaemic heart disease by acting on the venous coronary system. Three main classes of CSI have been proposed and tested: (1) retroperfusion technique, (2) retroinfusion technique and (3) coronary sinus occlusion techniques. They all share the principle that a controlled increased pressure within the coronary sinus may promote a retrograde perfusion of the ischaemic myocardium with consequent cardioprotection. Development of arterial treatments including coronary aortic bypass grafting and then percutaneous coronary intervention deflected interest from interventions on the coronary venous system. However, CSI may still have a possible niche role today in specific and selected clinical contexts in which existing therapies are insufficient. In this review paper, we aim to revise the rationale for CSI, describing the details and the evidence collected so far about these techniques and to provide insights about the main clinical scenarios in which these strategies may find a contemporary application in combination or as an alternative to existing approaches.
Department of Cardiology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Policlinico A. Gemelli, Rome, Italy.
Giovanni Luigi
GL
De Maria
Department of Cardiology, Cheltenham General Hospital, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK.
George
G
Kassimis
Department of Cardiology, Cheltenham General Hospital, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK.
Tushar
T
Raina
Department of Cardiology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
Adrian P
AP
Banning
D021721:Balloon Occlusion / Q000009:adverse effects; D006328:Cardiac Catheterization / Q000009:adverse effects; D017023:Coronary Angiography; D003326:Coronary Circulation; D054326:Coronary Sinus / Q000000981:diagnostic imaging / Q000503:physiopathology; D006439:Hemodynamics; D006801:Humans; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D015425:Myocardial Reperfusion / Q000009:adverse effects / Q000379:methods*; D018579:Patient Selection; D015641:Radiography, Interventional; D012307:Risk Factors; D016896:Treatment Outcome
CARDIAC PROCEDURES AND THERAPY