Veno-occlusive unloading of the heart reduces infarct size in experimental ischemia-reperfusion.

Abstract

Mechanical unloading of the left ventricle reduces infarct size after acute myocardial infarction by reducing cardiac work. Left ventricular veno-occlusive unloading reduces cardiac work and may reduce ischemia and reperfusion injury. In a porcine model of myocardial ischemia-reperfusion injury we randomized 18 pigs to either control or veno-occlusive unloading using a balloon engaged from the femoral vein into the inferior caval vein and inflated at onset of ischemia. Evans blue and 2,3,5-triphenyltetrazolium chloride were used to determine the myocardial area at risk and infarct size, respectively. Pressure-volume loops were recorded to calculate cardiac work, left ventricular (LV) volumes and ejection fraction. Veno-occlusive unloading reduced infarct size compared with controls (Unloading 13.9 ± 8.2% versus Control 22.4 ± 6.6%; p = 0.04). Unloading increased myocardial salvage (54.8 ± 23.4% vs 28.5 ± 14.0%; p = 0.02), while the area at risk was similar (28.4 ± 6.7% vs 27.4 ± 5.8%; p = 0.74). LV ejection fraction was preserved in the unloaded group, while the control group showed a reduced LV ejection fraction. Veno-occlusive unloading reduced myocardial infarct size and preserved LV ejection fraction in an experimental acute ischemia-reperfusion model. This proof-of-concept study demonstrated the potential of veno-occlusive unloading as an adjunctive cardioprotective therapy in patients undergoing revascularization for acute myocardial infarction.

• Authors: Esben Søvsø Szocska Hansen, Tobias Lynge Madsen, Gregory Wood, Asger Granfeldt, Nikolaj Bøgh, Bawer Jalal Tofig, Peter Agger, Jakob Lykke Lindhardt, Christian Bo Poulsen, Hans Erik Bøtker, Won Yong Kim
• Journal: Scientific reports (Sci Rep) Vol. 11 Issue 1 Pg. 4483 (02 24 2021) ISSN: 2045-2322 [Electronic] England
• PMID: 33627745 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Animals
• Coronary Circulation (physiology)
• Female
• Heart (physiopathology)
• Heart Ventricles (physiopathology)
• Heart-Assist Devices
• Hemodynamics (physiology)
• Myocardial Infarction (physiopathology)
• Myocardial Reperfusion (methods)
• Myocardial Reperfusion Injury (physiopathology)
• Myocardium (pathology)
• Swine
• Ventricular Function, Left (physiology)