Reduction of myocardial ischemia-reperfusion injury by mechanical tissue resuscitation using sub-atmospheric pressure.
BACKGROUND
Reperfusion-induced injury after myocardial infarction is associated with a well-defined sequence of early and late cardiomyocyte death. Most present attempts to ameliorate this sequence focus on a single facet of the complex process in an attempt to salvage cardiomyocytes. We examined, as proof of concept, the effects of mechanical tissue resuscitation (MTR) with controlled negative pressure on myocardial injury following acute myocardial infarction.


METHODS
Anesthetized swine were subjected to 75 minutes of left coronary artery occlusion and three hours of reperfusion. Animals were assigned to one of three groups: (A) untreated control; treatment of involved myocardium for 180 minutes of MTR with (B) -50 mmHg, or (C) -125 mmHg.


RESULTS
All three groups were subjected to equivalent ischemic stress. Treatment of the ischemic area with MTR for 180 minutes significantly (p < 0.001) reduced infarct size (area of necrosis/area at risk) in both treatment groups compared to control: 9.3 +/- 1.8% (-50 mmHg) and 11.9 +/- 1.2% (-125 mmHg) versus 26.4 +/- 2.1% (control). Total area of cell death was reduced by 65% with -50 mmHg treatment and 55% in the -125 mmHg group.


CONCLUSIONS
Treatment of ischemic myocardium with MTR, for a controlled period of time during reperfusion, successfully reduced the extent of myocardial death after acute myocardial infarction. These data provide evidence that MTR using subatmospheric pressure may be a simple, efficacious, nonpharmacological, mechanical strategy for decreasing cardiomyocyte death following myocardial infarction, which can be delivered in the operating room.
Argenta
Louis C
LC
Department of Plastic and Reconstructive Surgery, Wake Forest University Health Sciences, Winston-Salem, North Carolina 27157, USA. largenta@wfubmc.edu
Morykwas
Michael J
MJ
Mays
Jennifer J
JJ
Thompson
Edreca A
EA
Hammon
John W
JW
Jordan
James E
JE
D000818:Animals; D001274:Atmospheric Pressure; D016923:Cell Death; D005260:Female; D009203:Myocardial Infarction / Q000150:complications; D017202:Myocardial Ischemia / Q000209:etiology / Q000517:prevention & control* / Q000628:therapy; D015428:Myocardial Reperfusion Injury / Q000209:etiology / Q000517:prevention & control* / Q000628:therapy; D032383:Myocytes, Cardiac; D012151:Resuscitation / Q000379:methods*; D013552:Swine; D013997:Time Factors