OPTIMIZATION OF CORONARY VENOUS RETROPERFUSION METHODS

冠状静脉再灌注方法的优化

• 批准号: 3334828
• 负责人: ELIOT CORDAY
• 金额: $ 27.68万
• 依托单位: CEDARS-SINAI MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 1977
• 资助国家: 美国
• 起止时间: 1977-12-01 至 1990-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/3334828
• 关键词: angiography; arrhythmia; biomedical equipment safety; calcium channel blockers; cardiotonic agents; catheterization; clinical biomedical equipment; computer assisted diagnosis; coronary bypass; coronary occlusion /thrombosis; diltiazem; dogs; echocardiography; fibrinolytic agents; heart circulation; heart function; heart pharmacology; hemodynamics; histochemistry /cytochemistry; histopathology; induced hypothermia; mathematical model; myocardial infarct sizing; myocardial ischemia /hypoxia; particle; postmortem; procainamide; prostaglandins; radiotracer; streptokinase; swine

The proposed project is aimed at evaluation of coronary venous retroperfusion methods for treatment of myocardial ischemia. Prior studies have indicated that synchronized retroperfusion (SRP), during coronary artery occlusions can significantly increase myocardial perfusion and function in the profoundly ischemic zone, along with significantly enhancing viability of the jeopardized myocardium. Recently developed professionally manufactured SRP catheters and an integrated pump system are being evaluated for safety and effectiveness, and clinical trials are anticipated as soon as FDA permission is obtained. Preliminary checks in patients indicate that SRP catheters can be appropriately placed without difficulty and within minutes. Substantial interest in mechanisms and applications of SRP was evident at the first International Symposium on Myocardial Protection via the Coronary Sinus, held in Vienna in February 1984. Most recent laboratory emphasis has been on developing new methods and pilot experiments to elucidate retroperfusion mechanisms, and evaluate SRP techniques. Based on this work, a series of research projects are being proposed which are considered important: 1) assessment of factors affecting effective retrograde coronary venous delivery into ischemic myocardium; 2) extension of the state of the art to clinically pertinent timing of SRP followwing coronary occlusion, longer duration SRP treatment, and determination of post-SRP effects; 3) optimization of moderately hypothermic SRP; 4) retrograde infusion of cardioprotective drugs; 5) further study of retroperfusion protection against reperfusion "no reflow" derangements of function, metabolism, rhythm, edema/hemorrhages, and myocardial damage; 6) supplemental data on retrograde coronary venous route lysis of a coronary artery thrombus; 7) examination of alternate coronary venous interventions such as the recently proposed pressure controlled intermittent coronary sinus occlusion; 8) SRP during multiple/repetitive brief coronary artery occlusions, to examine retroperfusion treatment for complex PTCA procedures and other clinical states; 9) study of advantages and limitations of intraoperative cardioplegia via coronary sinus retroperfusion; 10) demonstration of integrated SRP system safety and clinical applicability. The significance of the proposed research is that future clinical SRP applications will be based on comprehensive criteria derived from experimental evaluation of methods over an appropriate range of physiologic conditions.

拟议项目旨在评估冠状静脉 用于治疗心肌缺血的逆灌注方法。 之前的研究 已经表明同步逆灌注（SRP），在冠状动脉 动脉闭塞可显着增加心肌灌注 深度缺血区的功能，以及显着 增强受损心肌的活力。 Recently developed 专业制造的 SRP 导管和集成泵系统 being evaluated for safety and effectiveness, and clinical trials are anticipated as soon as FDA permission is obtained. Preliminary checks in 患者表示 SRP 导管可以适当放置，无需 difficulty and within minutes. Substantial interest in mechanisms and applications of SRP was evident at the first International Symposium on Myocardial Protection via the Coronary Sinus, held in Vienna in February 1984. Most recent laboratory emphasis has been on developing new methods and pilot experiments to elucidate retroperfusion mechanisms, and evaluate SRP techniques. Based on this work, a series of research projects are being proposed which are considered important: 1) assessment of factors 影响冠状静脉有效逆行输送至缺血区 myocardium; 2) extension of the state of the art to clinically pertinent timing of SRP followwing coronary occlusion, longer duration SRP treatment, and determination of post-SRP effects; 3) optimization of moderately hypothermic SRP; 4) retrograde infusion of cardioprotective drugs; 5） further study of retroperfusion protection against reperfusion "no reflow" derangements of function, metabolism, rhythm, edema/hemorrhages, and myocardial damage; 6) supplemental data on retrograde coronary venous route lysis of a coronary artery thrombus; 7) examination of alternate coronary venous interventions such as the recently proposed pressure controlled intermittent coronary sinus occlusion; 8) SRP during multiple/repetitive brief coronary artery occlusions, to examine retroperfusion treatment for complex PTCA procedures and other clinical states; 9) study of advantages and limitations of intraoperative cardioplegia via coronary sinus retroperfusion; 10) demonstration of integrated SRP system safety and clinical applicability. The significance of the proposed research is that future clinical SRP applications will be based on comprehensive criteria derived from experimental evaluation of methods over an appropriate range of physiologic conditions.