Improved distribution of cardioplegia with pressure-controlled intermittent coronary sinus occlusion

Coronary occlusions may alter the distribution of antegrade cardioplegia and result in ischemic damage. This study was undertaken to determine whether pressure-controlled intermittent coronary sinus occlusion (PICSO) could improve antegrade cardioplegic delivery when coronary occlusions are present. Twenty pigs were subjected to 120 minutes of ischemic arrest with antegrade, multidose, potassium crystalloid cardioplegia. During arrest, the mid-left anterior descending artery was occluded with a snare, which was released on reperfusion. In 10 pigs, a balloon-tipped catheter was placed in the coronary sinus and PICSO was performed during each cardioplegia dose. PICSO-treated hearts had faster arrests (27 +/- 5 versus 102 +/- 21 [SE] seconds; p less than 0.02), as well as lower temperatures (18.4 +/- 1.0 versus 22.0 +/- 1.4 degrees C; p less than 0.05) and higher tissue pH (6.58 +/- 0.09 versus 6.31 +/- 0.09; p less than 0.05) just before aortic unclamping. Postischemic end-diastolic volume was unchanged with PICSO, but it decreased in non-PICSO-treated hearts. PICSO-treated hearts generated a higher postischemic stroke work index (0.70 +/- 0.08 versus 0.38 +/- 0.08 g-m/kg; end-diastolic volume, 60 ml; p less than 0.05). We conclude that PICSO improves cardioplegic distribution, thus reducing ischemic injury.