Percutaneous cardiopulmonary bypass limits myocardial injury from ischemic fibrillation and reperfusion.
Percutaneous implementation of cardiopulmonary bypass (PCPB) with a synchronous pulsatile pump has been shown to be an efficient means of unloading the heart. Therefore, this technique may provide a practical and effective method for treating patients undergoing a major cardiac catastrophe who are unresponsive to the usual resuscitative efforts. We tested whether PCPB could effectively unload the heart and provide myocardial salvage during left anterior descending (LAD) coronary artery occlusion complicated by ventricular fibrillation in the canine model (n = 13). All 13 dogs fibrillated within 20 minutes of LAD occlusion, and none could be successfully resuscitated by manual cardiac compression, sodium bicarbonate administration, antiarrhythmic agent administration, and electrical defibrillation. All 13 dogs were then placed on PCPB by way of the right jugular vein and right femoral artery; in seven, we used a synchronous pulsatile pump and in six a standard roller pump. No vent was placed in the left ventricle. All animals returned to normal sinus rhythm within 20 minutes of institution of PCPB. The LAD snare was released after 2 hours, and all animals were maintained on PCPB during 3 hours of reperfusion. At sacrifice, the area of infarction was determined by staining with triphenyltetrazolium chloride and was expressed as a percentage of the left ventricular area-at-risk for infarction. The tension time index was also measured and expressed as percent change from baseline. The left ventricular area-at-risk for infarction was similar in both groups (31.5% for roller pump vs. 29.2% for pulsatile pump; p greater than 0.05), but the area of infarction as a percentage of the area at risk was significantly smaller in the pulsatile-pump group (22.0%) than in the roller-pump group (35.4%; p less than 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)
Axelrod
H I
HI
Department of Surgery, New York University Medical Center, New York.
Murphy
M S
MS
Galloway
A C
AC
Baumann
F G
FG
Laschinger
J C
JC
Colvin
S B
SB
Spencer
F C
FC
D000818:Animals; D002315:Cardiopulmonary Bypass / Q000379:methods*; D003327:Coronary Disease / Q000150:complications / Q000473:pathology / Q000601:surgery*; D004285:Dogs; D009203:Myocardial Infarction / Q000209:etiology / Q000473:pathology; D015428:Myocardial Reperfusion Injury / Q000517:prevention & control*; D009206:Myocardium / Q000473:pathology*; D012307:Risk Factors; D014693:Ventricular Fibrillation / Q000150:complications / Q000473:pathology / Q000601:surgery*