SELECTIVE SUCTION AND PRESSURE-REGULATED RETROINFUSION - AN EFFECTIVEAND SAFE APPROACH TO RETROGRADE PROTECTION AGAINST MYOCARDIAL-ISCHEMIA IN PATIENTS UNDERGOING NORMAL AND HIGH-RISK PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY

Objectives. We sought to study the safety, feasibility and efficacy of selective suction and pressure regulated retroinfusion to protect aga inst myocardial ischemia in patients undergoing normal risk and high r isk balloon angioplasty.Background. In a pig model of acute myocardial ischemia it was previously shown that use of selective suction and pr essure-regulated retroinfusion was able to substantially preserve regi onal myocardial function during ischemia with a higher efficacy than t hat obtained with unselective synchronized retroperfusion. Methods. In 42 patients with normal risk (n = 27) or high risk (n = 15) percutane ous transluminal coronary angioplasty (PTCA), alternate balloon inflat ions of the left anterior descending coronary artery (60 s) were eithe r supported or not supported by selective suction and pressure regulat ed retroinfusion of the anterior interventricular vein. In an addition al group of 10 patients with normal risk, retroinfusion was directly c ompared with autoperfusion during 10 min of ischemia. Results. Balloon inflations without retroinfusion resulted in a decrease of regional m yocardial function in the ischemic zone to 13% of baseline. In contras t, regional myocardial function was preserved at 76% of baseline (p < 0.05) during balloon inflation supported by retroinfusion. This preser vation of regional myocardial function by retroinfusion was maintained during 10 min of ischemia with at least similar efficacy compared wit h autoperfusion. With retroinfusion, hemodynamic variables were stabil ized in normal risk and high risk patients. No complications related t o the catheterization of the anterior interventricular vein using a fe moral approach (95% success rate) were observed, and clinical follow-u p after 3 to 6 months was uneventful with regard to the coronary inter vention, Conclusions. Use of selective suction and pressure regulated retroinfusion was feasible and safe and had a high efficacy for preser ving regional myocardial function and hemodynamic variables during PTC A in normal risk and selected high risk patients. (C) 1998 by the Amer ican College of Cardiology.