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Myocardial salvage prior to emergency coronary bypass surgery for PTCA-induced coronary occlusion
U W Busch1, U Pfeiffer, R Bauer
1Medizinische Klinik, Institut für experimentelle Chirurgie, Institut für allgemeine Pathologie, Klinikum rechts der Isar, Technische Universität München, West Germany.
Insights
Prolonged, selective coronary perfusion using angioplasty catheters can prevent myocardial ischemia. This technique, tested in dogs, shows feasibility for reducing damage during percutaneous transluminal coronary angioplasty (PTCA).
Area of Science:
- Cardiovascular Research
- Biomedical Engineering
Background:
- Percutaneous transluminal coronary angioplasty (PTCA) can induce coronary occlusion, leading to myocardial ischemia.
- Selective coronary perfusion is a potential strategy to mitigate ischemia during such events.
Purpose of the Study:
- To evaluate the feasibility of prolonged, selective coronary perfusion using angioplasty catheters.
- To assess a novel pump system designed to minimize hemolysis during perfusion.
Main Methods:
- Development of a low-hemolysis pump for selective coronary perfusion.
- Testing the system in closed-chest dogs with induced coronary occlusion (LAD or Cx).
- Monitoring hemodynamic parameters and ECG to adjust flow rates (1-2.5 ml/min/kg).
Main Results:
- The developed pump demonstrated minimal hemolysis, independent of pump pressure.
- Catheter-induced hemolysis was primarily linked to turbulent jet effects through sideholes.
- Myocardial ischemia was significantly reduced or prevented for over 2 hours in 20 of 22 dogs.
- Perfusion pressures remained within safe limits throughout the procedure.
Conclusions:
- Prolonged, selective coronary perfusion is feasible with appropriate equipment.
- This technique can prevent ischemic myocardial damage in cases of PTCA-induced coronary occlusion.
- It offers a potential bridge therapy before surgical revascularization.
Abstract:
The possibility of prolonged, selective coronary perfusion via angioplasty catheters was evaluated. A pump was developed featuring minimal hemolysis even at high pump pressures. Pressure requirements differed greatly between various catheter types. Catheter-induced hemolysis did not correlate with pump pressure and was mainly due to a turbulent jet effect through sideholes. In 20 of 22 closed-chest dogs, myocardial ischemia could be greatly reduced or completely prevented for over 2 hours after proximal LAD or Cx occlusion. With flow rates between 1 and 2.5 ml/min/kg body weight and using the ECG and coronary venous O2 saturation for rate adjustment, pressure within the selectively perfused vessel never reached critical values. Thus, with the appropriate equipment, prolonged coronary perfusion is feasible. In some cases of percutaneous transluminal coronary angioplasty-(PTCA) induced coronary occlusion, it may prevent ischemic myocardial damage between PTCA-induced acute coronary occlusion and subsequent surgical revascularization.
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