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The Journal of Thoracic and Cardiovascular Surgery, Vol 103, 66-71, Copyright © 1992 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
JG Byrne, RF Appleyard, CC Lee, GS Couper, FG Scholl, RG Laurence and LH Cohn
Open-chest sheep underwent 90 minutes' occlusion of the diagonal branch of
the left anterior descending coronary artery, followed by vented
cardiopulmonary bypass. After 30 minutes of cardioplegic arrest, simulating
distal anastomoses, the occlusion on the coronary artery branch was
released. Controlled reperfusion (40 to 50 mm Hg, 135 to 150 ml/min) for
the first 20 minutes was delivered at the aortic root with either
unmodified whole blood (control, n = 7) or blood passed through leukocyte
filters (filters, n = 7). Serial measurements were made during 3 additional
hours reperfusion off cardiopulmonary bypass. During ischemia, the major
determinants of infarct size, which include area at risk, collateral
myocardial blood flow, and rate-pressure product were not significantly
different between groups. Overall, during reperfusion, mean left
ventricular stroke work index in the filter group was greater than in the
control group (28.7 +/- 5.8 versus 12.6 +/- 6.4 x 10(3) erg/gm, p less than
0.05), as was mean rate of rise of left ventricular pressure (1900 +/- 260
versus 1348 +/- 279 mm Hg/sec, p less than 0.05). Myocardial blood flow to
the area at risk at 3 1/2 hours of reperfusion in the filter group was also
significantly better than in the control group (0.57 +/- 0.15 versus 0.27
+/- 0.05 ml/min/gm, p less than 0.05), as was necrotic area as a percentage
of area at risk (40% +/- 6% versus 70% +/- 5%, p less than 0.05). These
results demonstrate amelioration of myocardial stunning and the no- reflow
phenomenon, as well as decreased infarct size. We conclude that controlled
reperfusion with leukocyte-depleted blood is superior to whole-blood
reperfusion for the surgical treatment of acute regional ischemia.
ARTICLES
Controlled reperfusion of the regionally ischemic myocardium with leukocyte-depleted blood reduces stunning, the no-reflow phenomenon, and infarct size
Department of Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Mass 02115.
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