Pressure-Controlled Intermittent Coronary Sinus Occlusion: A Novel Approach to Improve Microvascular Flow and Reduce Infarct Size in STEMI

Gibson, C. Michael; Ajmi, Issameddine; Koenig, Cajetan von; Turco, Mark; Stone, Gregg W.

doi:10.1016/j.carrev.2022.07.007

Cited by 6 publications

(3 citation statements)

References 31 publications

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“…Pressure-controlled intermittent coronary sinus occlusion (PiCSO) is a mechanical-catheter-based device that increases the mean coronary sinus pressure and coronary sinus pulse pressure intermittently post PCI. This protects the microvasculature by increasing its perfusion, salvaging more myocardium, and reducing complications such as heart failure or death [ 58 , 59 ]. PiCSO is limited to treating anterior STEMI [ 59 ].…”

Section: Cardioprotective Devices That Unload the Heartmentioning

confidence: 99%

“…PiCSO is limited to treating anterior STEMI [ 59 ]. The system consists of an 8F balloon-tipped catheter placed in the coronary sinus, controlled by a console; an algorithm constantly measures the coronary sinus pressures and coordinates the balloon inflation and deflation cycles [ 58 ]. Egred et al (2020) obtained the important conclusion that patients who received PiCSO after reperfusion have a significantly smaller infarct size at 5 days and no procedural or device-related adverse effects [ 59 ].…”

Section: Cardioprotective Devices That Unload the Heartmentioning

confidence: 99%

“…The effects of PiCSO in the heart reach a molecular level, by increasing relevant microRNA and transcription factors favoring cardiac regeneration by acting on cardiomyocytes and cardiac fibroblasts [ 60 ]. Further investigations are being conducted on PiCSO, yet there is still a lot to learn from this therapy; therefore, further investigation on this topic will be very beneficial ( Table 1 ) [ 58 , 59 , 60 , 102 ].…”

Section: Cardioprotective Devices That Unload the Heartmentioning

confidence: 99%

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The Use of Cardioprotective Devices and Strategies in Patients Undergoing Percutaneous Procedures and Cardiac Surgery

et al. 2023

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In the United States, about one million people are seen to visit the operating theater for cardiac surgery annually. However, nearly half of these visits result in complications such as renal, neurological, and cardiac injury of varying degrees. Historically, many mechanisms and approaches have been explored in attempts to reduce injuries associated with cardiac surgery and percutaneous procedures. Devices such as cardioplegia, mechanical circulatory support, and other methods have shown promising results in managing and preventing life-threatening cardiac-surgery-related outcomes such as heart failure and cardiogenic shock. Comparably, cardioprotective devices such as TandemHeart, Impella family devices, and venoarterial extracorporeal membrane oxygenation (VA-ECMO) have also been proven to show significant cardioprotection through mechanical support. However, their use as interventional agents in the prevention of hemodynamic changes due to cardiac surgery or percutaneous interventions has been correlated with adverse effects. This can lead to a rebound increased risk of mortality in high-risk patients who undergo cardiac surgery. Further research is necessary to delineate and stratify patients into appropriate cardioprotective device groups. Furthermore, the use of one device over another in terms of efficacy remains controversial and further research is necessary to assess device potential in different settings. Clinical research is also needed regarding novel strategies and targets, such as transcutaneous vagus stimulation and supersaturated oxygen therapy, aimed at reducing mortality among high-risk cardiac surgery patients. This review explores the recent advances regarding the use of cardioprotective devices in patients undergoing percutaneous procedures and cardiac surgery.

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Section: Cardioprotective Devices That Unload the Heartmentioning

confidence: 99%