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The Annals of Thoracic Surgery, Vol 48, 331-338, Copyright © 1989 by The Society of Thoracic Surgeons

ARTICLES

Reperfusion of infarcting myocardium: benefit of surgical reperfusion in a chronic model

EH Cheung, JM Arcidi Jr, LM Dorsey, J Vinten-Johansen, CR Hatcher Jr and RA Guyton
Department of Surgery, Carlyle Fraser Heart Center, Crawford Long Hospital, Emory University School of Medicine, Atlanta, Georgia.

Surgical reperfusion of experimental infarction leads to improved recovery of regional function compared with medical reperfusion, but sustained myocardial salvage has not been demonstrated. Twenty-two dogs were subjected to two hours of anterior descending occlusion and divided into three groups: group P (n = 7), no reperfusion; group M (n = 8), medical reperfusion; and group S (n = 7), controlled surgical reperfusion. Ischemia caused systolic bulging (-36% of control systolic shortening, p less than 0.01) and decreased regional work (9% of control pressure-length loop area, p less than 0.05). Thirty minutes after reperfusion group M had persistent systolic bulging (-9% of control systolic shortening) and decreased regional work (9% of control pressure-length loop area), whereas group S had +17% of control systolic shortening and 33% of control pressure-length loop area. After 1 week, regional function improved in all three groups (percent of control systolic shortening: group P, 26%; group M, 19%; group S, 52%), but systolic shortening was significantly better in group S (p less than 0.05 versus group M). Surgical reperfusion also resulted in one half of the eventual myocardial necrosis found in the other groups (group P, 45% of area at risk; group M, 38%; group S, 19%; p less than 0.05, group S versus group P or M). In this model, medical reperfusion offered no demonstrable benefit, whereas controlled surgical reperfusion led to a sustained (1 week) improvement in regional function and significant myocardial salvage.

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