OPTIMIZATION OF CORONARY VENOUS RETROPERFUSION METHODS

拟议的项目旨在评估冠状静脉 治疗心肌缺血的逆灌注法。先前的研究 有研究表明，在冠状动脉病变期间，同步逆灌(SRP) 动脉闭塞可显著增加心肌血流灌注和 在深度缺血区的功能，以及显著的 提高受损心肌的存活率。最近开发的 专业制造的SRP导管和集成泵系统 正在进行安全性和有效性评估，并进行临床试验 预计一旦获得FDA的许可，就会立即进行。初步办理入住手续 患者表示，SRP导尿管可以适当放置而不需要 困难，几分钟内就可以完成。对机械装置和 SRP的应用在首届国际研讨会上可见一斑 通过冠状静脉窦保护心肌，2月在维也纳举行 1984年。最近实验室的重点一直放在开发新方法上 和先导性实验，以阐明逆灌流机制，并评估 SRP技术。在此工作的基础上，开展了一系列研究项目 被认为重要的建议：1)评估因素 影响有效逆行冠状动脉静脉输注进入缺血的因素 心肌；2)将最新技术扩展到临床相关 冠状动脉闭塞后SRP的时机，更长时间的SRP治疗， 和SRP后效应的确定；3)适度优化 低温SRP；4)逆行输注心脏保护药物； 再灌流对再灌注“无复流”保护作用的进一步研究 功能、新陈代谢、节律、水肿/出血的紊乱，以及 心肌损伤；6)冠状动脉静脉逆行途径的补充数据 冠状动脉血栓溶解；7)冠状动脉交替检查 静脉干预，如最近提出的压力控制 间歇性冠状静脉窦闭塞；8)多次/重复时的SRP 短暂冠状动脉闭塞，以检查逆流治疗 复杂的经皮冠状动脉腔内成形术和其他临床状态；9)优势研究 冠状静脉窦停跳液术中应用的局限性 反灌流；10)综合SRP系统的安全性和 临床适用性。拟议研究的意义在于 未来的临床SRP应用将基于全面的标准 源自在适当范围内对方法进行的实验评估 生理条件。

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.