Invasive surgery reduces infarct size and preserves cardiac function in a porcine model of myocardial infarction.
Reperfusion injury following myocardial infarction (MI) increases infarct size (IS) and deteriorates cardiac function. Cardioprotective strategies in large animal MI models often failed in clinical trials, suggesting translational failure. Experimentally, MI is induced artificially and the effect of the experimental procedures may influence outcome and thus clinical applicability. The aim of this study was to investigate if invasive surgery, as in the common open chest MI model affects IS and cardiac function. Twenty female landrace pigs were subjected to MI by transluminal balloon occlusion. In 10 of 20 pigs, balloon occlusion was preceded by invasive surgery (medial sternotomy). After 72 hrs, pigs were subjected to echocardiography and Evans blue/triphenyl tetrazoliumchloride double staining to determine IS and area at risk. Quantification of IS showed a significant IS reduction in the open chest group compared to the closed chest group (IS versus area at risk: 50.9 ± 5.4% versus 69.9 ± 3.4%, P = 0.007). End systolic LV volume and LV ejection fraction measured by echocardiography at follow-up differed significantly between both groups (51 ± 5 ml versus 65 ± 3 ml, P = 0.033; 47.5 ± 2.6% versus 38.8 ± 1.2%, P = 0.005). The inflammatory response in the damaged myocardium did not differ between groups. This study indicates that invasive surgery reduces IS and preserves cardiac function in a porcine MI model. Future studies need to elucidate the effect of infarct induction technique on the efficacy of pharmacological therapies in large animal cardioprotection studies.
Experimental Cardiology Laboratory, University Medical Center Utrecht, Utrecht, The Netherlands.
Gerardus P J
GP
van Hout
Department of Respiratory Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
Michel P J
MP
Teuben
Department of Respiratory Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
Marjolein
M
Heeres
Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, The Netherlands.
Steven
S
de Maat
Department of Anesthesiology, Erasmus Medical Center, Rotterdam, The Netherlands.
Renate
R
de Jong
Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, The Netherlands.
Coen
C
Maas
Experimental Cardiology Laboratory, University Medical Center Utrecht, Utrecht, The Netherlands.
Lisanne H J A
LH
Kouwenberg
Department of Respiratory Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
Leo
L
Koenderman
Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, The Netherlands.
Wouter W
WW
van Solinge
Experimental Cardiology Laboratory, University Medical Center Utrecht, Utrecht, The Netherlands.
Saskia C A
SC
de Jager
Experimental Cardiology Laboratory, University Medical Center Utrecht, Utrecht, The Netherlands.|Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, The Netherlands.
Gerard
G
Pasterkamp
Experimental Cardiology Laboratory, University Medical Center Utrecht, Utrecht, The Netherlands.|Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, The Netherlands.
Imo E
IE
Hoefer
D000818:Animals; D004195:Disease Models, Animal; D004452:Echocardiography; D005260:Female; D006321:Heart / Q000503:physiopathology; D009203:Myocardial Infarction / Q000503:physiopathology / Q000601:surgery*; D015428:Myocardial Reperfusion Injury; D009206:Myocardium / Q000473:pathology; D020127:Recovery of Function; D013552:Swine
cardioprotection; infarct size reduction; invasive surgery; large animal models; myocardial infarction