Evidences for Inotropic Effects Induced by Simultaneous Antegrade and Retrograde Myocardial Perfusion in a Swine Model: Potential Applications for ECMO | Chapter 19 | Current Practice in Medical Science Vol. 5

 

Through retrograde perfusion into the coronary sinus, cardioplegia is delivered. In order to increase the left ventricle's myocardial oxygenation, we developed a pig beating-heart model of self-myocardial retroperfusion (SMR). The next step was to determine whether antegrade and retrograde myocardial perfusion with oxygenated blood could induce hemodynamic and cardiac responses as compared to a single antegrade myocardial supply. Eight pigs were given the task of simultaneously receiving SMR and antegrade physiological LAD perfusion. After the left azygos vein (LAV) was closed, SMR was carried out to selectively retrogradely perfuse the great cardiac vein with oxygenated blood utilizing a bypass line between the ascending aorta and the coronary sinus. Conductance catheters were used to measure cardiac output (CO), peak pressure in the left ventricle (Pmax in-LV), stroke volume (SV), left ventricular ejection fraction (LVEF), diastolic durations (DD), heart rate (HR), and arterial systemic pressure. The baseline duration of antegrade physiological myocardial perfusion and the concurrent antegrade and retrograde perfusion were used to acquire these results (SMR). In comparison to baseline data, SMR with concurrent antegrade LAD perfusion demonstrated inotropic characteristics and significant improvements in CO, SV, Pmax in-LV, and LVEF (p0.0001). Histology found no signs of tissular damage. A novel avenue for providing cardiac support has been opened up by the selective retrograde perfusion of the great cardiac vein with oxygenated blood (SMR), in conjunction with antegrade physiological LAD perfusion.

Author(s) Details:

Daniel Grandmougin,
School of Surgery, Université de Lorraine, France and  Department of Cardiovascular Surgery, CHRU Nancy, France and  Unité INSERM, UMR-S1116 DCAC, France.

Antoine Chalon,
School of Surgery, Université de Lorraine, France and Unité INSERM, UMR-S1116 DCAC, France.

Aude Falanga,
School of Surgery, Université de Lorraine, France.

Vanessa Marie,
School of Surgery, Université de Lorraine, France.

Fréderique Groubatch-Joineau,
School of Surgery, Université de Lorraine, France.

Brice Mourer,
School of Surgery, Université de Lorraine, France.

Pierre-Yves Marie,
Unité INSERM, UMR-S1116 DCAC, France.

Patrick Lacolley,
Unité INSERM, UMR-S1116 DCAC, France.

Nguyen Tran,
School of Surgery, Université de Lorraine, France and Unité INSERM, UMR-S1116 DCAC, France.

Please see the link here: https://stm.bookpi.org/CPMS-V5/article/view/7668