Left ventricular unloading with intra-aortic counter pulsation prior to reperfusion reduces myocardial release of endothelin-1 and decreases infarction size in a porcine ischemia-reperfusion model
✍ Scribed by John F. LeDoux; Sophie Tamareille; Patty R. Felli; James Amirian; Richard W. Smalling
- Publisher
- John Wiley and Sons
- Year
- 2008
- Tongue
- English
- Weight
- 292 KB
- Volume
- 72
- Category
- Article
- ISSN
- 1522-1946
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✦ Synopsis
Abstract
Objectives:
We tested the hypothesis that unloading the left ventricle with intra‐aortic balloon counter‐pulsation just prior to reperfusion provides infarct salvage compared with left ventricular (LV) unloading postreperfusion or reperfusion alone.
Background:
Previous reports demonstrated infarct salvage with complete LV unloading with an LVAD prior to reperfusion; however, partial LV unloading using intra‐aortic balloon pumps (IABPs) has not been evaluated.
Methods:
Twenty‐eight Yorkshire pigs were subjected to 1 hr of left anterior descending artery occlusion and 4 hr of reperfusion. An IABP was inserted and activated just prior to reperfusion (IABP‐Pre), or 15 min after reperfusion (IABP‐Post), or not at all (control).
Results:
At baseline, the hemodynamic data were similar in the three groups. Myocardial infarct size expressed a percentage of zone at risk in control animals was 44.9% ± 4.8%, IAPB‐Pre group 20.9% ± 5.1% (P < 0.05 compared to control), and IABP‐Post group 33.2 ± 6.1% (P = 0.16 vs. control group). There was a correlation between transcardiac endothelin‐1 release at 15 min postreperfusion and infarct size (r = 0.59).
Conclusion:
LV unloading with an IABP prior to reperfusion reduces the extent of myocardial necrosis in hearts subjected to 1 hr of left anterior descending artery occlusion and 4 hr of reperfusion compared with either reperfusion alone or LV unloading after reperfusion. Inhibition of myocardial ET‐1 release by LV unloading may be a significant mechanism of myocardial protection. These data suggest that in high‐risk STEMI patients, IABP unloading prior to reperfusion might be more beneficial than IABP placement postreperfusion. © 2008 Wiley‐Liss, Inc.