ESMOLOL AND PERCUTANEOUS CARDIOPULMONARY BYPASS ENHANCE MYOCARDIAL SALVAGE DURING ISCHEMIA IN A DOG-MODEL

Citation
Gw. Laub et al., ESMOLOL AND PERCUTANEOUS CARDIOPULMONARY BYPASS ENHANCE MYOCARDIAL SALVAGE DURING ISCHEMIA IN A DOG-MODEL, Journal of thoracic and cardiovascular surgery, 111(5), 1996, pp. 1085-1091
Citations number
41
Categorie Soggetti
Respiratory System","Cardiac & Cardiovascular System",Surgery
ISSN journal
00225223
Volume
111
Issue
5
Year of publication
1996
Pages
1085 - 1091
Database
ISI
SICI code
0022-5223(1996)111:5<1085:EAPCBE>2.0.ZU;2-J
Abstract
Despite recent advances in techniques of reperfusion for acute myocard ial ischemia, myocardial salvage remains suboptimal. beta-Blockers hav e been shown to limit infarct size during acute ischemia, but their ne gative inotropic properties have limited their use. Cardiopulmonary by pass is an attractive technique for cardiac resuscitation because it c an stabilize a hemodynamically compromised patient and potentially red uce myocardial oxygen consumption. In an attempt to maximize myocardia l salvage in the setting of acute ischemia, the combination of esmolol , an ultrashort-acting beta-blocker, with percutaneous cardiopulmonary bypass was evaluated. Four groups of instrumented dogs underwent 2 ho urs of myocardial ischemia induced by occlusion of the proximal left a nterior descending coronary artery, followed by 1 hour of reperfusion. Throughout the period of ischemia and reperfusion, esmolol plus percu taneous cardiopulmonary bypass was compared with esmolol alone, percut aneous cardiopulmonary bypass alone, and control conditions. After the reperfusion period, the extent of infarction of the left ventricle at risk was determined. Four animals had intractable arrhythmias: one in the esmolol plus bypass group, one in the esmolol group, and two in t he control group. The extent of infarction of the left ventricle at ri sk was significantly reduced in the esmolol plus bypass group (30%) co mpared with bypass alone (52%), with esmolol alone (54%), and with the control groups (59%; p < 0.05). We conclude that in this experimental model the combination of esmolol with bypass improves myocardial salv age after ischemia and reperfusion.