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Ann Thorac Surg 1985;40:504-508
© 1985 The Society of Thoracic Surgeons

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Articles

Reperfusion before Global Ischemic Arrest Improves the Salvage of Infarcting Myocardium

From the Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, MD.

^* Address reprint requests to Dr. Gardner, Division of Cardiac Surgery, Blalock 618, The Johns Hopkins Hospital, Baltimore, MD 21205

To study the effect of hypothermic global ischemic arrest on an evolving myocardial infarction and of perfusion of the ischemic zone or region at risk before global ischemia, 62 farm pigs underwent 15, 30, or 60 minutes of reversible coronary occlusion. Twenty-eight of these animals served as controls: reflow to the region at risk was established by removal of the coronary occluder without the addition of global ischemia. Another 26 animals had similar periods of coronary occlusion and then were placed on cardiopulmonary bypass; they underwent aortic cross-clamping and cardioplegia-induced global hypothermic arrest for 45 minutes. Eight additional pigs had two hours of reflow to the region at risk after removal of the occluder and before global ischemic arrest. When superimposed on regional ischemia, global ischemia resulted in a 6-fold increase in infarct size after 15 minutes of coronary occlusion (p < 0.05), a 2.2-fold increase after 30 minutes of coronary occlusion (p < 0.05), and no significant increase after 60 minutes of coronary occlusion. Reperfusion prior to global ischemia completely prevented infarct extension with 0.4% less infarction (not significant) in this group versus the controls without global ischemia.

These results clearly demonstrate that infarct extension occurring when global ischemia is superimposed on regional ischemia is greatest early in infarct evolution but that reflow to the region at risk before global ischemic arrest prevents the additional infarction. These data suggest that ischemic myocardium must be supplied with oxygen and metabolic substrate prior to global ischemic arrest to obtain maximum myocardial salvage with surgical revascularization.

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