HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Vinten-Johansen, J. Articles by Leaf, J. Search for Related Content PubMed PubMed Citation Articles by Vinten-Johansen, J. Articles by Leaf, J.

The Journal of Thoracic and Cardiovascular Surgery, Vol 92, 525-534, Copyright © 1986 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association

ARTICLES

Superiority of surgical versus medical reperfusion after regional ischemia

J Vinten-Johansen, GD Buckberg, F Okamoto, ER Rosenkranz, H Bugyi and J Leaf

This study tests the hypothesis that surgical revascularization (i.e., simulating coronary artery bypass grafting) with control of reperfusion conditions (total vented bypass) and of reperfusate composition (substrate-enriched blood cardioplegic solution) produces better recovery than is possible in the non-surgical setting (i.e., normal blood in beating, working hearts to simulate streptokinase and angioplasty). Eighteen dogs underwent 2 hours of left anterior descending coronary artery ligation (35% of the left ventricle at risk) followed by 2 hours of reperfusion. In five dogs the ligature was released to simulate streptokinase thrombolysis and angioplasty in working hearts (medical). In 13 dogs, surgical reperfusion was accomplished during total vented bypass, where six dogs received normal blood and seven others received substrate-enriched blood cardioplegic solution with 1 additional hour of aortic clamping (i.e., a total of 3 hours of ischemia). Segmental shortening with ultrasonic crystals, tissue water content, and vital staining (triphenyltetrazolium chloride) were assessed. Ischemia produced severe systolic bulging (- 42% of control systolic shortening, p less than 0.05). Medical reperfusion resulted in failure to restore regional contractility (-27% systolic shortening, p less than 0.05), severe edema (82.4% H2O content, p less than 0.05), and extensive transmural nonstaining (44%, p less than 0.05). In contrast, surgical reperfusion with substrate- enriched blood cardioplegic solution during total vented bypass restored regional contraction to 46% of control values (p less than 0.05) and resulted in less edema (80.6% H2O content, p less than 0.05), and only mild nonstaining (21%, p less than 0.05) restricted to the subendocardial region. Surgical revascularization with controlled reperfusion conditions and reperfusate composition produces better myocardial salvage than is possible in the medical setting, despite a longer period of ischemia.

This article has been cited by other articles:

				I. George and M. C. Oz Myocardial Revascularization after Acute Myocardial Infarction Card. Surg. Adult, January 1, 2008; 3(2008): 669 - 696. [Full Text]

				C. E. Darling, R. Jiang, M. Maynard, P. Whittaker, J. Vinten-Johansen, and K. Przyklenk Postconditioning via stuttering reperfusion limits myocardial infarct size in rabbit hearts: role of ERK1/2 Am J Physiol Heart Circ Physiol, October 1, 2005; 289(4): H1618 - H1626. [Abstract] [Full Text] [PDF]

				D. C. Lee, W. Ting, and M. C. Oz Myocardial Revascularization after Acute Myocardial Infarction Card. Surg. Adult, January 1, 2003; 2(2003): 639 - 658. [Full Text]

				K. Ihnken, K. Morita, G. D. Buckberg, B. Winkelmann, M. Schmitt, L. J. Ignarro, M.P. Sherman, and K. Ihnken Nitric-Oxide-Induced Reoxygenation Injury in the Cyanotic Immature Heart Is Prevented by Controlling Oxygen Content During Initial Reoxygenation Angiology, March 1, 1997; 48(3): 189 - 202. [Abstract] [PDF]

				M. S. Bhabra, D. N. Hopkinson, T. E. Shaw, and T. L. Hooper Critical Importance of the First 10 Minutes of Lung Graft Reperfusion After Hypothermic Storage Ann. Thorac. Surg., June 1, 1996; 61(6): 1631 - 1635. [Abstract] [Full Text]

				F. Beyersdorf Protection of Evolving Myocardial Infarction and Failed PTCA Ann. Thorac. Surg., September 1, 1995; 60(3): 833 - 838. [Abstract] [Full Text]

				T. Asai, E. A. Grossi, M. LeBoutillier III, M. A. Parish, F. G. Baumann, F. C. Spencer, S. B. Colvin, and A. C. Galloway Resuscitative retrograde blood cardioplegiaAre amino acids or continuous warm techniques necessary? J. Thorac. Cardiovasc. Surg., February 1, 1995; 109(2): 242 - 248. [Abstract] [Full Text]