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Choy JS, Hubbard T, Wang H, Awakeem Y, Khosravi P, Khadivi B, Navia JA, Stone GW, Lee LC, Kassab GS. Preconditioning with selective autoretroperfusion: In vivo and in silico evidence of washout hypothesis. Front Bioeng Biotechnol 2024; 12:1386713. [PMID: 38798957 PMCID: PMC11117169 DOI: 10.3389/fbioe.2024.1386713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 04/23/2024] [Indexed: 05/29/2024] Open
Abstract
Introduction Prompt reperfusion of coronary artery after acute myocardial infarction (AMI) is crucial for minimizing heart injury. The myocardium, however, may experience additional injury due to the flow restoration itself (reperfusion injury, RI). The purpose of this study was to demonstrate that short preconditioning (10 min) with selective autoretroperfusion (SARP) ameliorates RI, based on a washout hypothesis. Methods AMI was induced in 23 pigs (3 groups) by occluding the left anterior descending (LAD) artery. In SARP-b (SARP balloon inflated) and SARP-nb (SARP balloon deflated) groups, arterial blood was retroperfused for 10 min via the great cardiac vein before releasing the arterial occlusion. A mathematical model of coronary circulation was used to simulate the SARP process and evaluate the potential washout effect. Results SARP restored left ventricular function during LAD occlusion. Ejection fraction in the SARP-b group returned to baseline levels, compared to SARP-nb and control groups. Infarct area was significantly larger in the control group than in the SARP-b and SARP-nb groups. End-systolic wall thickness was preserved in the SARP-b compared to the SARP-nb and control groups. Analyte values (pH, lactate, glucose, and others), measured every 2 min during retroperfusion, suggest a "washout" effect as one important mechanism of action of SARP in reducing infarct size. With SARP, the values progressively approached baseline levels. The mathematical model also confirmed a possible washout effect of tracers. Discussion RI can be ameliorated by delaying restoration of arterial flow for a brief period of time while pretreating the infarction with SARP to restore homeostasis via a washout mechanism.
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Affiliation(s)
- Jenny S. Choy
- California Medical Innovations Institute, Inc., San Diego, CA, United States
| | | | - Haifeng Wang
- Department of Mechanical Engineering, Michigan State University, East Lansing, MI, United States
| | - Yousif Awakeem
- California Medical Innovations Institute, Inc., San Diego, CA, United States
| | | | - Bahram Khadivi
- Scripps Memorial Hospital, Division of Cardiology, La Jolla, CA, United States
| | - Jose A. Navia
- Department of Surgery, Austral University, Buenos Aires, Argentina
| | - Gregg W. Stone
- Division of Cardiology, Department of Medicine, Icahn School of Medicine at Mount Sinai, The Zena and Michael A. Wiener Cardiovascular Institute, New York, United States
| | - Lik Chuan Lee
- Department of Mechanical Engineering, Michigan State University, East Lansing, MI, United States
| | - Ghassan S. Kassab
- California Medical Innovations Institute, Inc., San Diego, CA, United States
- 3DT Holdings, LLC, San Diego, CA, United States
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Kuai F, Zhou L, Zhou J, Sun X, Dong W. Long non-coding RNA THRIL inhibits miRNA-24-3p to upregulate neuropilin-1 to aggravate cerebral ischemia-reperfusion injury through regulating the nuclear factor κB p65 signaling. Aging (Albany NY) 2021; 13:9071-9084. [PMID: 33675584 PMCID: PMC8034910 DOI: 10.18632/aging.202762] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/29/2020] [Indexed: 12/19/2022]
Abstract
Purpose: The aim of this study was to investigate the role of the tumor necrosis factor and HNRNPL related immunoregulatory long non-coding RNA (THRIL) in cerebral ischemia-reperfusion injury. Methods: A rat middle cerebral artery occlusion/ischemia-reperfusion (MCAO/IR) model and an oxygen glucose deprivation/reoxygenation (OGD/R) cell model were constructed. THRIL was knocked down using siTHRIL. Neurological deficit score was detected based on the criteria of Zea-Longa. Brain region 2,3,5-Triphenyltetrazolium (TTC) staining and quantitative analysis of cerebral infarction volume, RT-qPCR, and fluorescence immunostaining were performed for assessing THRIL expression. MTT assay was used to detect the cell proliferation ability after transfection, TUNEL assay was applied to detect apoptosis, and western blot and ELISA detected related protein expression. A dual luciferase reporter system and RIP assay were used to confirm the target relationship. Results: THRIL was upregulated in both in vitro and in vivo models of brain ischemia-reperfusion injury. Knockdown of THRIL attenuated OGD/R neuronal apoptosis and OGD/R-induced inflammation. THRIL targeted and regulated the expression of miR-24-3p/neuropilin-1 (NRP1) axis. THRIL silencing significantly improved the neurological functioning of rats in the MCAO/R model by miR-24-3p/NRP1/NF-κB p65 signaling pathway. Conclusion: THRIL could aggravate cerebral ischemia-reperfusion injury by competitively binding to miR-24-3p to promote the upregulation of NRP1 and further promoted the activation of the NF-κB p65 signaling pathway.
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Affiliation(s)
- Feng Kuai
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China.,Department of Geriatrics, The First People's Hospital of Yancheng, The Forth Affiliated Hospital of Nantong University, Yancheng 224001, China
| | - Liang Zhou
- Department of orthopedic, The People's Hospital of Lianshui, Huai'an 223001, China
| | - Jianping Zhou
- Department of Geriatrics, The First People's Hospital of Yancheng, The Forth Affiliated Hospital of Nantong University, Yancheng 224001, China
| | - Xuemei Sun
- Department of Geriatrics, The First People's Hospital of Yancheng, The Forth Affiliated Hospital of Nantong University, Yancheng 224001, China
| | - Wanli Dong
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
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Choy JS, Svendsen M, Lu X, Zheng H, Sulkin MS, Sinha AK, Morales C, Moussa I, Navia JA, Kassab GS. Selective autoretroperfusion preserves myocardial function during coronary artery ligation in swine. ACUTE CARDIAC CARE 2011; 13:99-108. [PMID: 21539459 DOI: 10.3109/17482941.2011.578748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND External pumps have been previously used to minimize edema and hemorrhage caused by coronary retroperfusion. The objective of this study was to use a pump-less approach (selective autoretroperfusion, SARP) to preserve myocardial function after acute coronary artery ligation. METHODS In five experimental pigs, the LAD artery was ligated distal to the first diagonal and retroperfusion was instituted for three hours from a brachiocephalic artery at 50 mmHg pressure through an adjustable occluder on the cannula. In eight control pigs, the LAD artery was ligated distal to the second diagonal for the same duration with no SARP. RESULTS ECG showed more prominent S-T segment elevation in the untreated control group despite the more distal ligation. The degree of myocardial contraction was significantly attenuated in the control group but was largely preserved in the SARP treated group. The myocytes were well preserved in the SARP group with no rupture of venous microvessels. Myocyte edema and disruption was observed in the control group with only mild extracellular edema in the SARP treated group. CONCLUSION SARP preserved myocardial function with no damage to the myocyte and venules during three hours of acute LAD ligation.
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Affiliation(s)
- Jenny S Choy
- Department of Biomedical Engineering, Indiana University Purdue University Indianapolis, USA
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Hale SL, Kloner RA. Mild Hypothermia as a Cardioprotective Approach for Acute Myocardial Infarction: Laboratory to Clinical Application. J Cardiovasc Pharmacol Ther 2010; 16:131-9. [DOI: 10.1177/1074248410387280] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In many animal models, mild therapeutic hypothermia is a powerful intervention, reducing myocardial infarct size, reducing the no-reflow phenomenon, and improving healing after infarction. Cooling in these models has been produced by various means including whole-body hypothermia, synchronized hypothermic coronary venous retro-perfusion, heat exchangers, and regional hypothermia targeting the heart alone. However, in humans, the most widely used techniques are surface cooling and cooling by endovascular heat-exchange catheters. The reduction in temperature necessary to produce cardioprotection is mild (32-34°C), appears to have no detrimental effects on left ventricular function or regional myocardial blood flow, and may improve microvascular reflow to previously ischemic heart tissue. It has been shown in experimental and clinical studies that for therapeutic hypothermia to be effective it must be (1) initiated as early as possible after the onset of ischemia and (2) initiated before reperfusion. This may require initiation of hypothermia in the ambulance, well before mechanical reperfusion occurs. The mechanisms of protection produced by hypothermia have yet to be conclusively determined but may include a decrease in tissue metabolic rate, preservation of high energy phosphates, a reduction in tissue apoptosis or induction of heat shock proteins.
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Affiliation(s)
- Sharon L. Hale
- The Heart Institute of Good Samaritan Hospital, Los Angeles, CA, USA,
| | - Robert A. Kloner
- The Heart Institute of Good Samaritan Hospital, Los Angeles, CA, USA, Keck School of Medicine, Division of Cardiovascular Medicine, University of Southern California, Los Angeles, CA, USA
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Onorati F, Santarpino G, Cristodoro L, Scalas C, Costanzo FS, Renzulli A. Continuous Coronary Sinus Perfusion Reverses Ongoing Myocardial Damage in Acute Ischemia. Artif Organs 2009; 33:788-97. [DOI: 10.1111/j.1525-1594.2009.00811.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Kassab GS, Navia JA, March K, Choy JS. Coronary venous retroperfusion: an old concept, a new approach. J Appl Physiol (1985) 2008; 104:1266-72. [PMID: 18292303 DOI: 10.1152/japplphysiol.00063.2008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
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.
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Affiliation(s)
- Ghassan S Kassab
- Department of Biomedical Engineering, Indiana University-Purdue University Indianapolis, 723 W. Michigan St., Indianapolis, IN 46202, USA.
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Ozmen S, Ayhan S, Demir Y, Siemionow M, Atabay K. Impact of gradual blood flow increase on ischaemia-reperfusion injury in the rat cremaster microcirculation model. J Plast Reconstr Aesthet Surg 2007; 61:939-48. [PMID: 17632046 DOI: 10.1016/j.bjps.2007.05.017] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2006] [Revised: 12/07/2006] [Accepted: 05/24/2007] [Indexed: 11/30/2022]
Abstract
INTRODUCTION We aimed to evaluate the impact of gradual blood reperfusion on ischaemia-reperfusion injury and to explain the pathophysiology of reperfusion injury in a rat cremaster muscle microcirculation model. MATERIALS AND METHODS Twenty-four Sprague-Dawley rats weighing 150-200 g were evaluated in three groups. Cremaster muscles were prepared for microcirculatory observations. Group I (n=8, control): no ischemia was induced. Group II (n=8, acute reperfusion): microclamps were applied to the right external iliac vessels for 150 min, then venous and arterial clamps were released at once. Group III (n=8, gradual reperfusion): microclamps were applied to the right external iliac vessels for 150 min, and then the first venous clamp was released; the arterial clamp was opened gradually by a specially designed microclamp holder (Sheey ossicle holding clamp). In all groups, following a wait of 150 min blood flow velocity was measured for 15 min and then the animals were reperfused freely for 1h. Next, red blood cell velocity, vessel diameters, functional capillary perfusion and endothelial oedema index were analysed, and rolling, migrating and adhesing leukocytes and lymphocytes were counted. All observations were videotaped for slow-motion replay. Muscle damage was evaluated histologically. RESULTS In the acute clamp release group, blood velocities increased up to 600% of their pre-ischaemic values during the post-ischaemia-reperfusion period. The numbers of rolling, adhering and transmigrating leukocytes were significantly higher and histological evaluation revealed more tissue damage in the acute reperfusion group. CONCLUSION Depending on histological and microcirculatory findings, gradual reperfusion was confirmed to reduce the intensity of reperfusion injury.
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Affiliation(s)
- Selahattin Ozmen
- Gazi University Faculty of Medicine, Department of Plastic, Reconstructive, and Aesthetic Surgery, Ankara, Turkey.
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Unal S, Ozmen S, DemIr Y, Yavuzer R, LatIfoğlu O, Atabay K, Oguz M. The effect of gradually increased blood flow on ischemia-reperfusion injury. Ann Plast Surg 2001; 47:412-6. [PMID: 11601577 DOI: 10.1097/00000637-200110000-00009] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Even with excellent operative techniques, prolonged ischemic periods may cause unwanted results because of a complex mechanism called reperfusion injury. Various pharmacological and immunological agents have been used to prevent this type of injury. Another known way to diminish reperfusion injury is the gradual reperfusion of the ischemic tissues. In this study, the effect of a gradual increase in blood flow on ischemia-reperfusion injury of the skeletal muscle was investigated. The right hind limbs of 15 rats were partially amputated, leaving the femoral vessels intact. Preischemic femoral arterial blood flow was measured by using a transonic small-animal blood flowmeter (T106) in all animals. The rats were divided into three groups: Group I consisted of control rats; no ischemia was induced. Group II was the conventional clamp release group. Clamps were applied to the femoral vessels to induce 150 minutes of ischemia. The clamps were then released immediately and postischemic blood flow was measured. Group III was the gradual clamp release group. After 150 minutes of ischemia, clamps were released gradually at a rate so that the blood flow velocity would reach one fourth the mean preischemic value at 30 seconds, one half at 60 seconds, three fourths at 90 seconds, and would reach its preischemic value at 120 seconds. Total clamp release was allowed when blood flow was less than 1.5 fold of the preischemic values. Postoperatively the soleus muscles were evaluated histopathologically, and malonyldialdehyde and myeloperoxidase levels were measured. The mean preischemic blood flow was 13.6 +/- 2.24 ml per kilogram per minute in all groups. In the conventional release group, postischemic flow reached four to five fold its preischemic values (61.06 ml per kilogram per minute). Histopathology revealed more tissue damage in the conventional release group. Malondialdehyde and myeloperoxidase levels were also significantly lower in the gradual release group. Depending on histological and biochemical findings, a gradual increase in blood flow was demonstrated to reduce the intensity of ischemia-reperfusion injury in the soleus muscle of this animal model.
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Affiliation(s)
- S Unal
- Department of Plastic and Reconstructive Surgery, Gazi University Medical Faculty, Ankara, Turkey
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Katircioglu SF, Gökçe P, Ulus AT, Tütün U, Apaydin N, Koç B. Reduction of the infarcted area with the use of simplified coronary sinus retroperfusion during experimental coronary artery occlusion. Int J Cardiol 2000; 73:115-21. [PMID: 10817848 DOI: 10.1016/s0167-5273(99)00213-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study examined if the use of simplified coronary sinus retroperfusion would lead to any reduction in the infarcted area associated with improved right and left ventricular function. Twelve mongrel dogs were entered in this study. Following anesthesia, a fast response thermistor was placed on the pulmonary artery via the jugular vein and aorta via the left ventricular apex. The left anterior descending artery (LAD) was separated from the vein. A retrograde cardioplegia catheter was inserted into the coronary sinus. Following these procedures, LAD was occluded for a period of 3.5 h. After 30 min ischemia, the aorta-coronary sinus connection was established. The animals were divided into two equal groups. One group was not treated and was considered the control group (six animals). In the remaining group (six animals), retroperfusion was used and was considered the retroperfusion group. At the end of the study, the left ventricular ejection fraction was 65+/-15% in the retroperfusion group and 48+/-5% in the control group (P<0.05). The left ventricular stroke work index was 0.44+/-0.04 (g m/kg) in the retroperfusion group and 0.31+/-0.05 (g m/kg) in the control group (P<0.05). Cardiac output was 1650+/-75 ml/min in the retroperfusion group and 1250+/-125 ml/min in the control group. The ratio of the infarct size to the area at risk was 49+/-5% in the control group and 7+/-3% in the retroperfusion group. In light of these studies, we conclude that simplified coronary sinus retroperfusion appears to be an effective method that must be taken into consideration.
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Affiliation(s)
- S F Katircioglu
- Cardiovascular Surgery Department, Turkiye Yüksek Ihtisas Hospital and Veterinary Faculty of Ankara University, Ankara, Turkey.
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von Degenfeld G, Peter W, Habazettl H, von Lüdinghausen M, Werdan K, Boekstegers P. Relationship between regional myocardial oxygenation and function during acute ischemia supported by selective suction and retroinfusion (SSR) in pigs. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 1998; 428:243-51. [PMID: 9500054 DOI: 10.1007/978-1-4615-5399-1_34] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- G von Degenfeld
- Department of Internal Medicine I, Klinikum Grosshadern, Germany
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Abstract
Myocardial apoptosis has previously been observed in human acute myocardial infarcts. We examined the time of appearance and extent of apoptosis in human acute myocardial infarcts, and compared these with necrotic cell death. Because nuclear internucleosomal DNA fragmentation is a hallmark of apoptosis, autopsied tissue from cases of acute myocardial infarct of varying histological ages was subjected to two tests that identify such fragmentation: in situ end-labeling (ISEL) and DNA electrophoresis on agarose gels. Both tests showed widespread apoptosis in infarcts only a few hours in age before the appearance of coagulative necrosis. No apoptosis was detected in normal myocardium. ISEL in recent infarcts was visible primarily in myocytes containing contraction bands, which occur predominantly in regions of reperfused myocardium. During the next 1 to 2 days, ISEL remained extensive but increasingly appeared in cells with morphological features of coagulative necrosis, representative of nonreperfused myocardium. In older infarcts, the incidence of apoptosis declined in myocytes, but increased in invading inflammatory cells. These data suggest that apoptosis is the early and predominant form of cell death in infarcted human myocardium, and that its appearance is accelerated in reperfused myocardium. Therapies directed at early rescue of apoptotic myocytes may, therefore, prove valuable.
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Affiliation(s)
- J P Veinot
- Department of Laboratory Medicine, Ottawa Civic Hospital, University of Ottawa Heart Institute, Ontario, Canada
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Aldea GS, Zhang X, Rivers S, Shemin RJ. Salvage of ischemic myocardium with simplified and even delayed coronary sinus retroperfusion. Ann Thorac Surg 1996; 62:9-15. [PMID: 8678691 DOI: 10.1016/0003-4975(96)00257-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Despite the proven efficacy of pressure-controlled intermittent coronary sinus obstruction (PICSO) and synchronized retrograde perfusion (SRP) in salvaging ischemic myocardium, wide application of these coronary sinus (CS) retroperfusion techniques has been limited by concerns about their safety and complexity and in particular the need for repeated occlusion of the CS with a balloon. To address these concerns a simplified retroperfusion technique (SR) was developed that continuously infuses superior vena caval blood at 7 mL/min into the CS catheter without balloon occlusion. METHODS Thirty pigs underwent 90 minutes of ischemia imposed by snaring the two largest diagonal branches of the left anterior descending artery and were randomized to one of five treatment groups: One group received no retroperfusion (control). Three groups had immediate (Im) institution of PICSO, SRP, or SR. In a final group, an initial 60 minutes of ischemia was followed by 30 minutes of delayed SR with superior vena caval blood. All animals were then placed on cardiopulmonary bypass and, after a 60-minute cardioplegic arrest, the coronary artery obstructions were removed, to simulate surgical revascularization. This was followed by 3 hours of reperfusion. The area of myocardium at risk and the area of infarction were determined by methylene blue and triphenyltetrazolium chloride staining with planimetric quantification. RESULTS Results are reported as mean +/- standard deviation. The area of the left ventricle at risk for infarction was similar in all the treatment groups and represented 22.3% +/- 4.1% of the left ventricular mass. The area of infarction after 3 hours of reperfusion was 48.5% +/- 11.0% for the control group, 26.8% +/- 7.3% for Im-PICSO, 24.9% +/- 4.8% for Im-SRP, 22.4% +/- 6.6% for Im-SR, and 27.7% +/- 7.2% for delayed SR (p < 0.01 for each group versus control). The mean CS pressure (in mm Hg) during treatment was 6.3 +/- 1.7 for the control group, 25.7 +/- 4.5 for Im-PICSO, 22.8 +/- 3.7 for Im-SRP, 5.0 +/- 1.5 for Im-SR, and 6.3 +/- 2.1 for delayed SR (p < 0.01 for Im-PICSO and Im-SRP versus control). CONCLUSIONS The simplified retroperfusion technique is as effective as PICSO and SRP in salvaging ischemic myocardium, but is considerably simpler. The simplified retroperfusion technique is inherently safer because of the lower CS pressures imposed by low flows and the lack of CS balloon obstruction. The efficacy of delayed SR has profound implications on possible mechanisms of ischemic myocardial salvage. Further investigation is warranted.
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Affiliation(s)
- G S Aldea
- Department of Cardiothoracic Surgery, Boston University Medical Center, Massachusetts 02118-2393, USA
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Zhou X, Bai J, Yiang F. The effects of intra-aortic balloon pumping combined with coronary sinus interventions on failing hearts: a model study. Comput Biol Med 1996; 26:241-53. [PMID: 8725775 DOI: 10.1016/0010-4825(96)00005-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Cardiac energy balance is an important factor in evaluating cardiac function. In this work, the effects of different assist modalities and their combinations on cardiac energy balance and global cardiac function have been investigated. The simulation results indicate that coronary sinus interventions (CSIs) can provide myocardium with more energy than IABP when coronary arterial stenosis is serious. However, IABP can decrease myocardial energy consumption and enhance cardiac output, which cannot be done by CSIs, under the condition of impaired myocardial contractility. Therefore, we conclude that the combination of IABP and CSIs is the best way of assisting failing circulation.
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Affiliation(s)
- X Zhou
- Department of Electrical Engineering, Tsinghua University, Beijing, P.R. China
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Beranek JT. Laser-mediated transmural myocardial channels induce a hyalin degeneration of neighboring myocardium. J Am Coll Cardiol 1994; 23:1518. [PMID: 7513721 DOI: 10.1016/0735-1097(94)90403-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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