非体外循环主动脉-冠状窦分流逆行灌注对急性缺血心肌的保护

Aortic-coronary sinus shunt retroperfusion protects against acute myocardial ischemia in pigs during off-pump beating heart surgery

目的探讨在非体外循环心脏不停跳经冠状窦持续灌注动脉血对急性心肌缺血的保护作用和安全性.方法实验猪通过套扎冠状动脉前降支120min复制急性心肌缺血模型,然后松解套扎线60 min恢复灌注.随机分为3组:第1组为对照组,在第2、3组,缺血60 min后接受主动脉-冠状静脉窦分流进行逆灌60 min,冠状窦压分别控制在40～50mmHg(低压组)和70～80mmHg(高压组).术中测定各时点血流动力学和冠状窦静脉血一氧化氮(NO)和内皮素-1(ET-1)变化,术毕测定左心室心肌梗塞范围.结果在缺血180min,第2、3组左室压上升或下降速率(±dp/dtmax)比对照组提高,NO浓度较高而ET-1较低,心梗面积分别比对照组减少45%和61%.结论非体外循环下经冠状窦逆行灌注可以减少急性缺血/再灌注后左室收缩和舒张功能不全和内皮细胞损伤,高压逆灌可以抢救更多的濒危心肌.

Objective To investigate the protective effect and safety of coronary sinus retroperfusion (CSR) with aortic oxygenated blood for acute myocardial ischemia during off-pump beating heart surgery in pigs. Methods Eighteen pigs were subjected to 120 min of acute myocardial ischemia by ligation of the lateral anterior descending branch (LAD) of the coronary artery followed by 60 min of reperfusion by lifting LAD ligation. The pigs were divided into 3 groups after the above operation, including a control group (group 1) and low- and high-pressure retroperfusion groups (groups 2 and 3), and in the latter two groups the pigs received 60 min of aorta-coronary sinus shunt retroperfusion (ACSSR) following 60 min of ischemia with self- or manually inflated balloon-tipped cannula inserted to induce low or high-pressure, respectively. The left ventricular function and measurements of coronary sinus nitric oxide (NO), endothelin-1 (ET-1) and infarct size were recorded. Results Three hours after ischemia, the maximal left ventricular pressure increment to reduction rates in groups 2 and 3 were much higher than those of group 1, with also higher NO and lower ET-1 concentrations in the coronary sinus blood. The infarct size was reduced by 45% and 61% in groups 2 and 3, respectively, as compared with that of group 1. Conclusion ACSSR can reduce left ventricular systolic and diastolic dysfunction, protect coronary endothelial function, and reduce infarct size for rescue of the acutely ischemic myocardium in pigs during off-pump beating heart surgery.