The salvage potential of coronary sinus interventions: meta-analysis and pathophysiologic consequences

Abstract

The use of intermittent coronary sinus occlusion and intermittent coronary sinus occlusion in combination with retroperfusion of arterial blood significantly decreases ischemic damage during coronary occlusions. Intermittent coronary sinus occlusion in combination with retroperfusion exhibits no significant profit in salvaging the ischemic myocardium in comparison with that provided by intermittent coronary sinus occlusion alone.

Myocardial Protection Via the Coronary Sinus Long-Term Effects of Intermittent Coronary Sinus Occlusion as an Adjunct to Reperfusion in Acute Myocardial Infarction

“…Syeda and colleagues reported no statistical difference in the salvage potential between these 2 methods in a meta-analysis of both methods, and showed that salvage was related to the developed pressure in the coronary sinus (CS). 3 Although both methods never reached widespread scientific acceptance, clinical data from a few human trials are available for both methods. 4,5 Retroperfusion was mainly studied in supporting coronary interventions and in cardiac surgery.…”

Basic and applied research at the department of cardio-thoracic surgery: work in progress

“…Using PICSO we were able to show in a canine model with 6 hours of permanent coronary artery occlusion a 50% infarct size reduction rated against the area at risk and an increase of the occluded coronary artery pressure. These data were corroborated worldwide and a Meta analysis of comparable data with different models of ischemia and reperfusion in different species of experimental animals showed a mean of 30% infarct size reduction [56,57].…”

PICSO: from myocardial salvage to tissue regeneration

“…Syeda et al reported a significant reduction in infarct size of 29.3% in the pICSO group compared to the control group (p b 0.001; 95% confidence interval, −40.9 to −17.7), which correlated to the achieved (developed) coronary sinus pressure increase per minute (r = −0.92; p b 0.007) [52]. This dose-dependency has been recently confirmed by the Prepare RAMSES study, which showed a significant correlation (r = 0.70, p = 0.008) in reduction in infarct size and the cumulated coronary sinus pressure modulation over time [53].…”

“…occlusion duration and elevation of the coronary venous systolic pressure per minute multiplied by the application times of ICSO) and infarct size [52]. The so-called "dose dependence" between optimized ICSO therapy and salvage has been documented in different species and different durations of ischemia [52].…”