ENHANCED RECOVERY OF ISCHEMIC MYOCARDIUM BY COMBINING PERCUTANEOUS BYPASS WITH INTRAAORTIC BALLOON PUMP SUPPORT

Although percutaneous bypass (PB) can support the failing myocardium, regional ischemic damage may still occur beyond a coronary occlusion. This study sought to determine whether the addition of intraaortic bal loon pump (IABP) support to PB would result in more optimal salvage of ischemic myocardium. In 30 pigs, the second and third diagonal vessel s were occluded with snares for 90 minutes followed by 30 minutes of c ardioplegic arrest and 3 hours of reperfusion with the snares released . During the period of coronary artery occlusion, 10 pigs were placed on PB, 10 pigs received PB plus IABP support, and 10 pigs received no support (the unmodified group). The hearts treated with the combinatio n of PB and IABP support exhibited the highest wall motion scores (3.3 +/- 0.20 for the PB plus IABP group [p < 0.05 from the unmodified gro up and from the PB group]; versus 1.40 +/- 0.30 for the PB group versu s 1.37 +/- 0.33 for the unmodified group), the least tissue acidosis ( change in pH, -0.30 +/- 0.2 for the PB plus IABP group [p < 0.05 from the PB group] versus -0.60 +/- 0.10 for the PB group versus -0.41 +/- 0.13 for the unmodified group), and the least area of necrosis (25% +/ - 5% for the PB plus IABP group [p < 0.05 from the unmodified group an d from the PB group]; versus 43% +/- 2% for the PB group [p < 0.05 fro m the unmodified group] versus 73% +/- 3% for the unmodified group). W e conclude that IABP support should be added to PB to obtain the most optimal results during surgical revascularization of acutely ischemic myocardium.