Reduction of systolic and diastolic dysfunction by retrograde coronary sinus perfusion during off-pump coronary surgery Manuel Castellá, MD, Gerald D.

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Reduction of systolic and diastolic dysfunction by retrograde coronary sinus perfusion during off-pump coronary surgery Manuel Castellá, MD, Gerald D Buckberg, MD The Journal of Thoracic and Cardiovascular Surgery Volume 127, Issue 4, Pages 1018-1025 (April 2004) DOI: 10.1016/j.jtcvs.2003.09.013

Figure 1 Aorta to CS shunt, connecting an antegrade to retrograde cardioplegia cannulas through a Luer connection. Two different retrograde cannulas were used with self-inflating textured balloon and manually inflating balloon. The Journal of Thoracic and Cardiovascular Surgery 2004 127, 1018-1025DOI: (10.1016/j.jtcvs.2003.09.013)

Figure 2 Systolic dysfunction: Percentage of contraction during systole versus baseline values in the different groups. Values expressed as mean ± SEM. (*P < .01, occlusive CS shunt vs non-occlusive CS shunt and ischemic groups; **P < .05, CS shunt groups vs ischemic group.) CS, Coronary sinus. The Journal of Thoracic and Cardiovascular Surgery 2004 127, 1018-1025DOI: (10.1016/j.jtcvs.2003.09.013)

Figure 3 Diastolic dysfunction: Percentage of diastole in which contraction was detected. Values expressed as mean ± SEM. (*P < .05, occlusive CS shunt group vs control ischemia group). CS, Coronary sinus. The Journal of Thoracic and Cardiovascular Surgery 2004 127, 1018-1025DOI: (10.1016/j.jtcvs.2003.09.013)

Figure 4 Percentage of baseline NO production in CS plasma at 30 and 60 minutes after ischemia. Values expressed as mean ± SEM. (*P < .05 vs unprotected ischemia group). LAD, Left anterior descending; CS, coronary sinus. The Journal of Thoracic and Cardiovascular Surgery 2004 127, 1018-1025DOI: (10.1016/j.jtcvs.2003.09.013)

Figure 5 Pressure-segment length work loops in the anterior free wall of the left ventricle before ischemia, during 15 minutes of LAD occlusion, and after 15, 30, and 60 minutes of LAD reperfusion of control non-ischemic (left circumflex coronary artery), control ischemic (LAD), and occlusive shunt (LAD) groups. Note the shift of the loop to the right in the ischemic heart (indicating muscular distention) and the bent to the right (indicating dyskinesia). LV, Left ventricle; CS, coronary sinus; LCx, left circumflex coronary artery. The Journal of Thoracic and Cardiovascular Surgery 2004 127, 1018-1025DOI: (10.1016/j.jtcvs.2003.09.013)

Figure 6 Raw tracings of myocardial segment lengths in control ischemia (LAD) and occlusive CS shunt (LAD) groups during 15 minutes of LAD occlusion and after 15 minutes, 30 minutes, and 60 minutes of LAD reperfusion. Note the elevation of the tracing in the ischemic heart during ischemia and reperfusion, indicating distention, poor contraction during systole, and extension of contraction into diastole. LVP, Left ventricular pressure; CS, coronary sinus. The Journal of Thoracic and Cardiovascular Surgery 2004 127, 1018-1025DOI: (10.1016/j.jtcvs.2003.09.013)