Reply to H.S. Bedi and M.S. Kalkat

• We would like to thank Dr Bedi and Dr Kalkat for drawing attention to another potential application of retrograde perfusion of the coronary sinus with oxygenated blood. The connection of the aortic and retrograde cannula to allow retrograde perfusion is beautiful in its simplicity. In contrast to our report on retrograde perfusion to treat severe myocardial ischemia during early stages of surgery, they seem to have employed retrograde perfusion in off pump surgery to avoid ischemia. However, in some cases they observed regression of ECG changes as retrograde perfusion was commenced. Although these type of clinical reports (like our own report) almost inevitably are anecdotal they do have a scientific basis (references given in the respective reports). According to current knowledge of coronary sinus anatomy and interventions, retrograde coronary sinus perfusion has the potential to alleviate myocardial ischemia caused by obstruction of antegrade flow to myocardium drained by the coronary sinus. This is in agreement with the reported experience by Drs Bedi and Kalkat, who found signs of ischemia only while performing anastomoses to the right coronary artery.Certainly, the method described deserves further evaluation in off pump surgery as it potentially allows unhurried anastomosis, and it could contribute to a reduced need for conversion to on-pump procedures and an increasing proportion of off-pump procedures in multi-vessel coronary disease. If the latter, on the other hand, is a desirable evolution for the majority of patients remains to be established.

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MEDICINE

MEDICIN

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vet (subject category)

art (subject category)