A novel selective autoretroperfusion strategy proposing a gradual increase in venous pressure to arterial values may prevent vein damage and combat myocardial ischemia.
Proposes a novel hypothesis for coronary venous retroperfusion by gradually increasing venous pressure to arterial values to prevent edema and hemorrhage in patients with severe myocardial ischemia.
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 has prevented routine clinical utility in the catheterization laboratory. 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 that 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 prearterializations of the veins before 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.
Kassab et al. (Fri,) conducted a review in Myocardial ischemia. Coronary venous retroperfusion was evaluated. A novel selective autoretroperfusion strategy proposing a gradual increase in venous pressure to arterial values may prevent vein damage and combat myocardial ischemia.