Submitted on January 21, 2008
Accepted on February 12, 2008
Coronary Venous Retroperfusion: An Old Concept, a New Approach
Ghassan S. Kassab1*, Jose A. Navia2, Keith March3, and Jenny S. Choy4
1 Biomedical Engineering, SL-174, Indiana University Purdue University Indianapolis, Indianapolis, Indiana, United States
2 Surgery, Austral University, Buenos Aires, Argentina
3 Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, Indiana, United States
4 Biomedical Engineering, Indiana University Purdue University Indianapolis, Indianapolis, Indiana, United States
* To whom correspondence should be addressed. E-mail: gkassab{at}iupui.edu.
The potential of the coronary veins for revascularization has been evaluated by many investigators for more than a century. The major hurdle has been the damage of veins during sudden exposure to arterial pressure. The solution to this problem has typically involved the use of intricate and complicated apparatus and devices which have prevented routine clinical utility in the catheterization lab. This review examines this old concept from a new perspective and proposes a novel hypothesis to address previous shortcomings. We speculate on an approach that may serve to eliminate the edema and hemorrhage which result during venous retroperfusion as the pressure is suddenly increased to arterial values. We propose the rationale to increase the venous pressure to arterial values more gradually to allow pre-arterializations of the veins prior to full exposure of arterial pressure. Finally, we discuss various possible indications for this selective autoretroperfusion strategy to combat myocardial ischemia in cardiogenic shock patients, ST-elevation myocardial infarct patients, no-option patients, and beyond.
