A feasibility and safety study of intracoronary hemodilution during primary coronary angioplasty in order to reduce reperfusion injury in myocardial infarction

McGarvey, Michael L.; Omar, Ali; Iqbal, Mohammad; Ilsley, Charles; Wong, Joyce; Mario, Carlo Di; Redwood, Simon; Patterson, Tiffany; Pennell, Dudley J.; Rogers, Paula; Dalby, Miles

doi:10.1002/ccd.27136

Cited by 1 publication

(6 citation statements)

References 36 publications

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“…33 Other researchers as well as clinical trials have used cold isotonic saline delivered with conventional catheters. 12,34,35 Isotonic saline is inexpensive and readily available. The decreased complexity of this approach warrants exploration.…”

Section: Discussionmentioning

confidence: 99%

“…Assuming a core body temperature of 37°C, the catheter provides 38 W of cooling at this flow rate. This cooling capacity is similar to recently published human pilot studies using chilled saline perfusion and was chosen to reduce tissue temperatures to values <35°C, shown to be linked with better outcomes in humans 12–14 . In these studies, standard guide catheters are used and have not been designed to provide localized heart tissue cooling.…”

Section: Methodsmentioning

confidence: 99%

“…At 60 min of occlusion, the snares were released and uninterrupted cooling was continued for 25 min following reperfusion. The occlusion duration and the cooling duration post‐reperfusion were selected based on previous work and current pilot human studies 12,13,18 . Then, to avoid abrupt temperature changes, a 5‐min stepwise controlled rewarming was conducted by gradually decreasing the autologous blood flow rate and the catheter was removed.…”

Section: Methodsmentioning

confidence: 99%

“…This cooling capacity is similar to recently published human pilot studies using chilled saline perfusion and was chosen to reduce tissue temperatures to values <35 C, shown to be linked with better outcomes in humans. [12][13][14] In these studies, standard guide catheters are used and have not been designed to provide localized heart tissue cooling. This catheter design limitation is evident from their thin walls (~0.01 in.…”

Section: Cooling Guide Catheter and Consolementioning

confidence: 99%

“…The occlusion duration and the cooling duration post-reperfusion were selected based on previous work and current pilot human studies. 12,13,18 Then, to avoid abrupt temperature changes, a 5-min stepwise controlled rewarming was conducted by gradually decreasing the autologous blood flow rate and the catheter was removed. Animals were reperfused for a total of 3 hr.…”

Section: Animal Protocolmentioning

confidence: 99%

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Myocardial tissue salvage is correlated with ischemic border region temperature at reperfusion

Merrill

Mitchell

Merrill

et al. 2019

Cathet Cardio Intervent

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Objectives: Our pilot study investigated the association between region-specific myocardial tissue temperature and tissue salvage using a novel tri-lumen cooling catheter to provide rapid localized cooling directly to the heart in an open-chest porcine model of ischemia-reperfusion. Background: Therapeutic hypothermia remains a promising strategy to limit reperfusion injury following myocardial ischemia. Methods: Large swine underwent 60 min of coronary occlusion followed by 3 hr of reperfusion. Prior to inducing ischemia, six temperature probes were placed directly on the heart, monitoring myocardial temperatures in different locations. Hemodynamic parameters and core temperature were also collected. Approximately 15 min prior to reperfusion, the cooling catheter was inserted via femoral artery and the distal tip advanced proximal to the occluded coronary vessel under fluoroscopic guidance. Autologous blood was pulled from the animal via femoral sheath and delivered through the central lumen of the cooling catheter, delivering at 50 ml/min, 27 C at the distal tip. Cooling was continued for an additional 25 min after reperfusion followed by a 5-min controlled rewarming. Hearts were excised and assessed for infarct size per area at risk. Results: Although cooling catheter performance was consistent throughout the study (38 W), the resulting tissue cooling was not. Our results show a correlation between myocardial tissue salvage and ischemic border region (IBR) temperature at the time of reperfusion (R 2 = 0.59, p = 0.027). IBR tissue is the tissue located at the boundary between healthy and ischemic tissues. Conclusions: Our findings suggest that localized, rapid, short-term myocardial tissue cooling has the potential to limit reperfusion injury in humans.

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