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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
Author(s) -
LeDoux John F.,
Tamareille Sophie,
Felli Patty R.,
Amirian James,
Smalling Richard W.
Publication year - 2008
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.21698
Subject(s) - medicine , cardiology , myocardial infarction , ischemia , endothelin 1 , aortic root , infarction , myocardial reperfusion injury , reperfusion injury , aorta , receptor
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.