Experimental Left Coronary Artery Perfusion Through an Aortotomy During Cardiopulmonary Bypass

Littlefield, James B.; Lowicki, Edward M.; Muller, William H.

doi:10.1016/s0022-5223(19)32591-7

Cited by 17 publications

(2 citation statements)

References 4 publications

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“…Based on ear ly experiences with continuous coronary perfusion (10,12), and recently reported result s using ult ra-short jlblockade (14, 18) we develop ed, in an attempt to improv e myocard ial prote ction, a technique based on the principle of continuous coronary per fusion in conjunction with ultra-short actin g selective~l-bl ockad e and nitroglycerine.…”

Section: Discussionmentioning

confidence: 99%

Myocardial Protection by Pressure- and Volume-Controlled Continuous Hypothermic Coronary Perfusion (PVC-CONTHY-CAP) in Combination with Ultra-Short Beta-Blockade and Nitroglycerine

Borowski

Korb²

1997

Thorac cardiovasc Surg

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The aim of the study was to validate clinically a new technique of myocardial protection developed for intra- and extra-cardiac surgery on the beating heart. The concept combines the principle of continuous pressure- and volume-controlled coronary artery perfusion (PVC-CONTHY-CAP) with the specific myocardioprotective effects of hypothermia and nitrates and, on the other hand, with the beta-blocker-mediated reduction of chronotropy and inotropy necessary for convenient surgery. Under standard ECC conditions after cross-clamping the aorta coronary perfusion with oxygenated blood enriched with nitroglycerine (10 micrograms/kg/h) and esmolol (0.05 mg/ml flow/min) is started via an additional perfusion cannula placed in the aortic root. The temperature of the perfusate is maintained at 32 degrees C, the intraaortic pressure at 40-70 mmHg and the perfusion flow in the range 0.8-1.0 ml/g heart muscle/min. In CABG procedures an additional perfusion catheter is used for perfusion of distal coronary artery segments. Using this technique 100 consecutive patients, adults and children, were operated on between 2/96 and 8/96. In 84 adult patients (age: 45-82 yrs), 78 CABG procedures (54 elective, 13 urgent, 11 acute) with a mean bypass count of 3.7 (range 1-7), 69 ITA grafts, 72 grafts to CX, and 3 MVRec/MVRpl, and 6 pure MVRec/MVRpl procedures (1 urgent, 1 emergency) were performed. The mean coronary perfusion time was 48 min (range 21-88 min). In 5 patients perioperative infarction (CABG; 1 emergency after PTCA, 4 elective) with significant increase of CK-MB values (57-98 U/L) occurred. In the 4 elective patients (3 with diabetes mellitus) re-intervention was not possible due to small-vessel disease. In one patient with preoperative infarction IABP was necessary. No patient died. There were 16 children (age: 4weeks-16 yrs): VSD, n = 6, AV-C, n = 2, TOF, n = 1, MVRec, n = 1, DORV (Rastelli), n = 2, SV (TCPC), n = 3, and PV obstruction, n = 1. The mean coronary perfusion time was 97 min (range: 27-260 min). The mean ICU stay 3.9 d (range: 1-10 d). One child died (TCPC) on the 10th postoperative day due to multi-organ failure. In conclusion, PVC-CONTHY-CAP is designed especially for emergency and urgent procedures, i.e. patients with PTCA-related complications, patients with severely depressed LV function, and patients with complex congenital cyanotic heart defects. Using PVC-CONTHY-CAP, coronary artery bypass grafting as well as intracardiac procedures for congenital and acquired heart defects can be performed safely and conveniently, the system is easy to handle for both the cardiac surgeon and perfusionist. Due to its pharmacological properties continuous intracoronary application of nitrates in combination with hypothermia seems to be essential as a preventive treatment modality for the ischemic state.

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Section: Discussionmentioning

confidence: 99%

Myocardial Protection by Pressure- and Volume-Controlled Continuous Hypothermic Coronary Perfusion (PVC-CONTHY-CAP) in Combination with Ultra-Short Beta-Blockade and Nitroglycerine

Borowski

Korb²

1997

Thorac cardiovasc Surg

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“…In the following 20 years, the mortality rate in cardiac surgery had been between 10–20% . The myocardial protection method included systemic and/or topical hypothermia , continuous or intermittent aortic occlusion , aortic root or intracoronary blood perfusion , or electrically induced ventricular fibrillation . The first successful pharmacological arrest was used by Bretschneider in 1964 and this was the initial form of today's histidine‐tryptophan‐ketoglutarate (HTK) solution .…”

mentioning

confidence: 99%

Myocardial Protection in Pediatric Cardiac Surgery

Türköz

2013

Artificial Organs

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The combination of hypothermia and potassium cardioplegic arrest has become the most common method of myocardial protection in the evolution of myocardial protection. This review focuses on myocardial protection in pediatric cardiac surgery. In the 1980s, blood was added to cardioplegia solution in order to supply the myocardium with oxygen, nutrients, and for buffering purposes. Similar myocardial protection methods have been used in adult and pediatric groups for many years. However, the immature heart in the pediatric group differs in many ways from the mature hearts in adults. Low cardiac output is more often observed in pediatric patients. Most cardiac operations are performed under cardioplegic arrest in pediatric cardiac surgery. Today there are a lot of different types of cardioplegia solutions and methods used in pediatric cardiac surgery. Soon after normothermic perfusion was used in the adult cardiac surgery in the beginning of the 1990s, normothermic perfusion and cardioplegia began to be used in pediatric myocardial protection. Myocardial protection is more challenging in particular cases such as: (i) long and complex cases in which repetitive cardioplegia administration through the aortic root is difficult; (ii) newborn patients; and (iii) cases with preoperative damaged myocardium. If the mortality and morbidity rates of the centers in complex and long procedures are higher than the reported rates in literature, the myocardial protection method must be suspected and reorganized.

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Myocardial Protection in Children

Doğan

Türköz

2020

Cardiac Surgery

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Experimental Left Coronary Artery Perfusion Through an Aortotomy During Cardiopulmonary Bypass

Cited by 17 publications

References 4 publications

Myocardial Protection by Pressure- and Volume-Controlled Continuous Hypothermic Coronary Perfusion (PVC-CONTHY-CAP) in Combination with Ultra-Short Beta-Blockade and Nitroglycerine

Myocardial Protection by Pressure- and Volume-Controlled Continuous Hypothermic Coronary Perfusion (PVC-CONTHY-CAP) in Combination with Ultra-Short Beta-Blockade and Nitroglycerine

Myocardial Protection in Pediatric Cardiac Surgery

Myocardial Protection in Children

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