Chapter category: Heart
Coronary Venous Retroinfusion During Interventional Cardiology
Coronary Sinus Intervention in Cardiac Surgery, Second Edition
Edited by: Werner MohlISBN: 1-58706-006-X
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Chapter authors:
Peter Boekstegers
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During the past decade, several percutaneous support devices for coronary angioplasty have been developed with the aim of improving myocardial tolerance to ischemia, thereby increasing the safety of coronary angioplasty and allowing the expansion of its indications. Thus, supported coronary angioplasty has been applied in patients with high risk conditions such as multivessel disease, unstable angina, impaired left ventricular function and myocardial infarction complicated by cardiogenic shock.1-5 In the event of abrupt vessel closure during coronary angioplasty, mechanical support devices may provide a bridge until reperfusion is established1,4 either by repeated coronary angioplasty or by emergency bypass surgery. The broader application of percutaneous support devices for high risk coronary angioplasty, however, is still limited by their inadequate efficacy or by complications associated with their use.1,5-7
Three main approaches have been chosen for mechanical support of acutely ischemic myocardium during coronary angioplasty: antegrade methods, whole heart support and retroinfusion of coronary veins (Fig. 1).
Antegrade methods provide regional support of the ischemic myocardium through the balloon catheter, i.e. autoperfusion8 or pumping of either autologous blood9,10 or synthetic oxygen carriers.11-14 Regional myocardial protection, however, is not ensured until the stenotic lesion has been passed. Thus, antegrade methods may be difficult to apply in patients with unstable hemodynamic conditions, in patients with tortuous, small or diffusely disease vessels as well as in patients with sequential stenoses.1
Support of the whole heart independent of the stenotic lesion is possible using cardiopulmonary bypass,2,15 intraaortic balloon counterpulsation1 as well as left ventricular assist devices.5 Though hemodynamic stability may be preserved using these techniques,2,5,15 regional myocardial ischemia persists during coronary angioplasty. Furthermore, significant complications increasing morbidity and mortality of high risk coronary angioplasty have been observed using cardiopulmonary bypass.7
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