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J Thorac Cardiovasc Surg 1996;111:1085-1091
© 1996 Mosby, Inc.

CARDIOPULMONARY BYPASS, MYOCARDIAL MANAGEMENT, AND SUPPORT TECHNIQUES

ESMOLOL AND PERCUTANEOUS CARDIOPULMONARY BYPASS ENHANCE MYOCARDIAL SALVAGE DURING ISCHEMIA IN A DOG MODEL

From the Division of Cardiothoracic Surgery, Department of Surgery, Deborah Heart and Lung Center and Deborah Research Institute, Browns Mills, N.J., and the Department of Surgery, UMDNJ–Robert Wood Johnson Medical School, New Brunswick, N.J.

Presented in part at the American College of Chest Physicians, Chicago, October 1992.

Received for publication Jan. 3, 1995 Accepted for publication July 3, 1995. Address for reprints: Glenn W. Laub, MD, Attending Surgeon, Assistant Professor of Surgery, Deborah Heart and Lung Center, Browns Mills, NJ 08015.

Abstract

Despite recent advances in techniques of reperfusion for acute myocardial ischemia, myocardial salvage remains suboptimal.ß-Blockers have been shown to limit infarct size during acute ischemia, but their negative inotropic properties have limited their use. Cardiopulmonary bypass is an attractive technique for cardiac resuscitation because it can stabilize a hemodynamically compromised patient and potentially reduce myocardial oxygen consumption. In an attempt to maximize myocardial salvage in the setting of acute ischemia, the combination of esmolol, an ultrashort-actingß-blocker, with percutaneous cardiopulmonary bypass was evaluated. Four groups of instrumented dogs underwent 2 hours of myocardial ischemia induced by occlusion of the proximal left anterior descending coronary artery, followed by 1 hour of reperfusion. Throughout the period of ischemia and reperfusion, esmolol plus percutaneous cardiopulmonary bypass was compared with esmolol alone, percutaneous cardiopulmonary bypass alone, and control conditions. After the reperfusion period, the extent of infarction of the left ventricle at risk was determined. Four animals had intractable arrhythmias: one in the esmolol plus bypass group, one in the esmolol group, and two in the control group. The extent of infarction of the left ventricle at risk was significantly reduced in the esmolol plus bypass group (30%) compared with bypass alone (52%), with esmolol alone (54%), and with the control groups (59%; p < 0.05). We conclude that in this experimental model the combination of esmolol with bypass improves myocardial salvage after ischemia and reperfusion. (J THORACCARDIOVASCSURG1996;111:1085-91)

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