OPTIMIZATION OF CORONARY VENOUS RETROPERFUSION METHODS

该项目旨在评价冠状静脉 用于治疗心肌缺血的逆向灌注方法。 先前研究 已经表明，在冠状动脉造影期间， 动脉闭塞可显著增加心肌灌注， 在深度缺血区发挥作用，沿着 增强受损心肌的存活力。 最近开发 专业制造的SRP导管和集成泵系统， 正在评估安全性和有效性，临床试验正在 预计一旦获得FDA许可。 初步检查 患者表示，SRP导管可以适当放置， 困难，几分钟内。 对各种机制和 在第一届国际研讨会上， 2月在维也纳举行的通过冠状窦保护心肌会议 1984. 最近实验室的重点是发展新的方法 和试点实验，以阐明逆向灌注机制，并评估 SRP技术。 在此基础上，开展了一系列研究项目， 被认为是重要的：1）评估因素 影响有效的逆行冠状静脉输送到缺血 心肌; 2）将最新技术水平扩展至临床相关 冠状动脉闭塞后SRP的时机，更长时间的SRP治疗， 和确定后SRP的影响; 3）优化适度 低温SRP; 4）心脏保护药物逆行输注; 5） 逆灌流对再灌注“无复流”保护作用的进一步研究 功能、代谢、节律紊乱、水肿/水肿，以及 心肌损伤; 6）逆行冠状静脉途径的补充数据 冠状动脉血栓溶解术; 7）检查交替冠状动脉 静脉介入例如最近提出的压力控制 间歇性冠状窦闭塞; 8）多次/重复性 短暂的冠状动脉闭塞，检查逆向灌注治疗， 复杂的PTCA手术和其他临床状态; 9）优势研究 术中经冠状静脉窦心脏停搏的局限性 逆向灌注; 10）证明集成SRP系统的安全性， 临床适用性。 拟议研究的意义在于， 未来的临床SRP应用将基于综合标准 源自对适当范围内方法的实验评价 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.