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Ann Thorac Surg 1981;32:475-485
© 1981 The Society of Thoracic Surgeons

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Articles

Reduction of Myocardial Infarct Size in Swine: A Comparative Study of Intraaortic Balloon Pumping and Transapical Left Ventricular Bypass

From the Department of Surgery, Division of Cardiac Surgery, and the Department of Medicine, Division of Cardiology, Michael Reese Hospital and Medical Center, and the Department of Surgery Division of Cardiac Surgery, The University of Chicago, Pritzker School of Medicine, Chicago, IL

Accepted for publication February 12, 1981.

^* Address reprint requests to Dr. Campbell, Division of Cardiac Surgery, Michael Reese Hospital and Medical Center, 2929 S Ellis Ave, Chicago, IL 60616

This study compared intraaortic balloon pumping (IABP) and transapical left ventricular (LV) bypass for their effectiveness in reducing infarct size in swine. In 28 pigs (25.4 ± 4.7 kg) the left anterior descending coronary artery was ligated distal to the first diagonal branch. Nine animals served as controls. Nine animals were treated with IABP and the remaining 10, with transapical bypass. Ten animals—3 control, 3 IABP, and 4 transapical bypass—died prior to completion of the study, thereby resulting in 6 animals in each group. Both assist devices were begun 45 minutes after coronary ligation, this being as rapid as mechanical intervention could be accomplished in the patient after infarction. With transapical LV bypass, 70 to 100% bypass was accomplished and the LV systolic pressure remained in the range between mean aortic pressure and 30 mm Hg less than that. All animals were killed after 24 hours. The hearts were excised and stained with nitroblue tetrazolium, and infarct size was quantitated in grams of infarct per 100 gm of LV and septal mass.

After 24 hours the mean aortic pressure was 73 ± 12 mm Hg in controls, 105 ± 20 mm Hg in animals with IABP (p < 0.01), and 91 ± 13 mm Hg in those with transapical LV bypass (p < 0.05). The infarct size was 22.7 ± 4.9 gm per 100 gm of LV and septal mass in control animals. With IABP, the infarct size was nonsignificantly changed to 19.4 ± 5.9 gm per 100 gm (p > 0.3). With transapical LV bypass, the infarct size was significantly reduced to 15.9 ± 3.5 gm per 100 gm (p < 0.025). This represented a 30% reduction of infarct size from controls.

These results demonstrate that despite hemodynamic improvement with IABP, transapical LV bypass is necessary to markedly decrease myocardial work and significantly reduce infarct size.

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