title: Reperfusion Damage　- A Story of Success, Failure, and Hope.
abstract: Tissue salvage of severely ischemic myocardium requires timely reperfusion by thrombolysis, angioplasty, or bypass. However, recovery of left ventricular function is rare. It may be absent or, even worse, reperfusion can induce further damage. Laboratory studies have shown convincingly that reperfusion can increase injury over and above that attributable to the pre-existing ischemia, precipitating arrhythmias, suppressing the recovery of contractile function ("stunning") and possibly even causing cell death in potentially salvable ischemic tissue. The mechanisms of reperfusion injury have been widely studied and, in the laboratory, it can be attenuated or prevented. Disappointingly, this is not the case in the clinic, particularly after thrombolysis or primary angioplasty. In contrast, excellent results have been achieved by surgeons by means of cardioplegia and hypothermia. For the interventionist, the issue is more complex as, contrary to cardiac surgery where the cardioplegia can be applied before ischemia and the heart can be stopped, during an angioplasty the heart still has to beat to support the circulation. We analyze in detail all these issues.
authors.affiliation: Cardiovascular and LTTA Centre, Azienda Ospedaliera-Universitaria di Ferrara.
authors.forename: Roberto
authors.initials: R
authors.lastname: Ferrari
authors.forename: Cristina
authors.initials: C
authors.lastname: Balla
authors.forename: Michele
authors.initials: M
authors.lastname: Malagù
authors.forename: Gabriele
authors.initials: G
authors.lastname: Guardigli
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Morciano
authors.forename: Matteo
authors.initials: M
authors.lastname: Bertini
authors.forename: Simone
authors.initials: S
authors.lastname: Biscaglia
authors.forename: Gianluca
authors.initials: G
authors.lastname: Campo
mesh_terms: D000818:Animals; D006801:Humans; D017202:Myocardial Ischemia / Q000473:pathology / Q000628:therapy*; D015425:Myocardial Reperfusion / Q000009:adverse effects; D015428:Myocardial Reperfusion Injury / Q000517:prevention & control*; D013997:Time Factors; D016277:Ventricular Function, Left