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Published on: March 12, 2018
Protective effect of active perfusion in porcine models of acute myocardial ischemia
Zanxiang Feng1, Zhifu Mao1, Shengjun Dong2
1Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China.
Insights
Active perfusion significantly reduces myocardial injury and apoptosis during acute myocardial ischemia compared to shunt perfusion. This finding is crucial for improving outcomes in high-risk cardiac surgery patients.
Area of Science:
- Cardiovascular Surgery
- Myocardial Ischemia Research
- Surgical Innovation
Background:
- Off-pump coronary artery bypass (CAB) carries high mortality rates, particularly in high-risk patients.
- Acute myocardial ischemia presents a significant challenge in cardiac interventions.
- Evaluating protective strategies is essential for improving patient outcomes.
Purpose of the Study:
- To establish porcine models of acute myocardial ischemia.
- To evaluate the protective efficacy of active perfusion versus traditional shunt perfusion.
- To assess the impact on myocardial injury markers and apoptosis.
Main Methods:
- Randomized assignment of 30 pigs into five groups: Sham, shunt (55% and 75% stenosis), and active perfusion (55% and 75% stenosis).
- Induction of myocardial ischemia via descending artery stenosis.
- Measurement of hemodynamic parameters (aortic pressure, coronary pressure, perfusion pressure).
- Assessment of inflammatory markers (TNF-α, IL-6, IL-10), cardiac injury markers (cTnI, CK-MB), apoptosis markers (Bcl-2, caspase-3), and myocardial apoptosis rate.
Main Results:
- Successful construction of porcine models with 55% and 75% stenosis.
- Ischemia significantly decreased coronary perfusion pressure and increased inflammatory and apoptosis markers, while decreasing Bcl-2.
- Active perfusion (Group B) significantly improved coronary perfusion pressure and reduced inflammatory markers, cardiac injury, and apoptosis compared to shunt perfusion.
- Active perfusion demonstrated a higher expression of the anti-apoptotic protein Bcl-2.
Conclusions:
- Active perfusion is more effective than shunt perfusion in maintaining myocardial perfusion during acute myocardial ischemia.
- Active perfusion significantly alleviates ischemic myocardial injury and reduces apoptosis.
- These findings suggest active perfusion as a superior strategy for high-risk cardiac procedures.
Abstract:
Mortality rates associated with off‑pump coronary artery bypass (CAB) are relatively high, as the majority of patients requiring CAB are at a high risk for cardiac events. The present study aimed to establish porcine models of acute myocardial ischemia, and evaluate the protective role of shunt and active perfusion. A total of 30 pigs were randomly assigned to five groups, as follows: i) Sham (control); ii) A1 (shunt; stenosis rate, 55%); iii) A2 (shunt; stenosis rate, 75%); iv) B1 (active perfusion; stenosis rate, 55%); and v) B2 (active perfusion; stenosis rate, 75%) groups. Aortic pressure (P0), left anterior descending coronary pressure (P1), and coronary effective perfusion pressure (P1/P0) were measured. The expression levels of tumor necrosis factor‑α (TNF‑α), cardiac troponin (cTnI), creatine kinase‑myocardial band (CK‑MB), interleukin (IL)‑6, IL‑10, B‑cell lymphoma 2 (Bcl‑2), and caspase‑3 were detected using enzyme‑linked immunosorbent assay or western blotting. The myocardial apoptosis rate was determined using the terminal deoxynucleotidyl transferase dUTP nick end labeling assay. Ischemia models with stenosis rates of 55 and 75% were successfully constructed following suturing of the descending artery. Compared with the control, the 55 and 75% stenosis groups demonstrated significantly decreased P1/P0, increased expression levels of TNF‑α, cTnI, CK‑MB, IL‑6, IL‑10 and caspase‑3, an increased rate of myocardial apoptosis, and a decreased expression level of anti‑apoptotic protein, Bcl‑2. At 30 min following successful establishment of the model (ST segment elevation to 1 mm), group B demonstrated significantly increased P1/P0, decreased expression levels of TNF‑α, cTnI, CK‑MB, IL‑6, IL‑10 and caspase‑3, a decreased rate of myocardial apoptosis, and an increased expression level of anti-apoptotic protein, Bcl‑2. Furthermore, the current study indicated that active perfusion was more efficacious in maintaining myocardial perfusion and alleviating ischemic injury when compared with traditional shunt perfusion.
