Veno-occlusive unloading of the heart reduces infarct size in experimental ischemia-reperfusion

• Published in: Scientific reports Vol. 11; no. 1; p. 4483
• Main Authors: Hansen, Esben Søvsø Szocska, Madsen, Tobias Lynge, Wood, Gregory, Granfeldt, Asger, Bøgh, Nikolaj, Tofig, Bawer Jalal, Agger, Peter, Lindhardt, Jakob Lykke, Poulsen, Christian Bo, Bøtker, Hans Erik, Kim, Won Yong
• Format: Journal Article
• Language: English
• Published: England Nature Publishing Group 24.02.2021; Nature Publishing Group UK; Nature Portfolio
• Subjects: Ejection fraction; Heart; Heart attacks; Ischemia; Mechanical unloading; Myocardial infarction; Myocardial ischemia; Reperfusion; Triphenyltetrazolium chloride; Unloading; Ventricle
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-021-84025-y

Mechanical unloading of the left ventricle reduces infarct size after acute myocardial infarction by reducing cardiac work. Left ventricular veno-occlusive unloading reduces cardiac work and may reduce ischemia and reperfusion injury. In a porcine model of myocardial ischemia-reperfusion injury we randomized 18 pigs to either control or veno-occlusive unloading using a balloon engaged from the femoral vein into the inferior caval vein and inflated at onset of ischemia. Evans blue and 2,3,5-triphenyltetrazolium chloride were used to determine the myocardial area at risk and infarct size, respectively. Pressure-volume loops were recorded to calculate cardiac work, left ventricular (LV) volumes and ejection fraction. Veno-occlusive unloading reduced infarct size compared with controls (Unloading 13.9 ± 8.2% versus Control 22.4 ± 6.6%; p = 0.04). Unloading increased myocardial salvage (54.8 ± 23.4% vs 28.5 ± 14.0%; p = 0.02), while the area at risk was similar (28.4 ± 6.7% vs 27.4 ± 5.8%; p = 0.74). LV ejection fraction was preserved in the unloaded group, while the control group showed a reduced LV ejection fraction. Veno-occlusive unloading reduced myocardial infarct size and preserved LV ejection fraction in an experimental acute ischemia-reperfusion model. This proof-of-concept study demonstrated the potential of veno-occlusive unloading as an adjunctive cardioprotective therapy in patients undergoing revascularization for acute myocardial infarction.