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Conditioned blood reperfusion during angioplasty (CoBRA) treatment of acute myocardial infarction

Acute myocardial infarct (MI) results in ischemia distal to lesions which puts heart muscle at risk for reperfusion injury (RI). Neutrophils, platelets and complement are putative mediators of RI. Recent advances in filtration technology provide integrated neutrophil and platelet removal together wi...

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Published in:Perfusion 2001-03, Vol.16 (1_suppl), p.39-49
Main Authors: Patel, Mrugesh B, Kilgore, Kenneth S, Ortolano, Girolamo A, Gryboski, Cyndy L, Qureshi, Mansoor A, Marcovitz, Pamela, Naylor, Keith B, Park, James L, Wenz, Barry, Gikakis, Nicolas, Freedman, Robert J, Lucchesi, Benedict R, O’Neill, William W
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creator Patel, Mrugesh B
Kilgore, Kenneth S
Ortolano, Girolamo A
Gryboski, Cyndy L
Qureshi, Mansoor A
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Naylor, Keith B
Park, James L
Wenz, Barry
Gikakis, Nicolas
Freedman, Robert J
Lucchesi, Benedict R
O’Neill, William W
description Acute myocardial infarct (MI) results in ischemia distal to lesions which puts heart muscle at risk for reperfusion injury (RI). Neutrophils, platelets and complement are putative mediators of RI. Recent advances in filtration technology provide integrated neutrophil and platelet removal together with complement-attenuating properties in a single blood-conditioning device. The present study characterizes the properties of a blood-conditioning filter and describes its clinical effect when used in conjunction with active hemoperfusion for acute MI.The filter reduces leukocytes by 99.9998 ± 0.0002% (p
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Neutrophils, platelets and complement are putative mediators of RI. Recent advances in filtration technology provide integrated neutrophil and platelet removal together with complement-attenuating properties in a single blood-conditioning device. The present study characterizes the properties of a blood-conditioning filter and describes its clinical effect when used in conjunction with active hemoperfusion for acute MI.The filter reduces leukocytes by 99.9998 ± 0.0002% (p&lt;0.0001) and platelets by 99.9934 ± 0.0069% (p&lt;0.0001). Human plasma, derived from heparinized blood that was ‘conditioned’ by filtration, was studied using the Langendorff isolated rabbit heart preparation. The deposition of membrane attack complex and the resultant functional myocardial impairments [reflected in hemodynamic and biochemical measurements, including developed pressure, coronary blood flow, lymph-derived myocardial creatine kinase (CK)] are significantly attenuated by blood conditioning. Integration of the blood-conditioning filter into an active hemoperfusion system during primary percutaneous transluminal coronary angioplasty (PTCA) for acute MI (n=8) did not delay the procedure or cause any complications. Reperfusion of occluded coronary arteries with 300 cm3 of conditioned blood led to significant improvement in echocardiographic global wall motion scores (in standard deviations) following treatment (1.64 ± 0.18 to 1.45 ± 0.15, p=0.02).Initial reperfusion of totally occluded coronary arteries with conditioned blood leads to acutely improved ventricular function. Collectively, these data provide a strong indication for continued investigation of conditioned blood reperfusion in angioplasty following acute MI for the long-term effect upon recovery of salvagable myocardium.</description><identifier>ISSN: 0267-6591</identifier><identifier>EISSN: 1477-111X</identifier><identifier>DOI: 10.1177/026765910101600i106</identifier><identifier>PMID: 11334205</identifier><language>eng</language><publisher>Thousand Oaks, CA: SAGE Publications</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Angioplasty ; Angioplasty, Balloon, Coronary - methods ; Animals ; Arteries ; Blood flow ; Blood plasma ; Blood pressure ; Cardiac muscle ; Complement ; Complement Membrane Attack Complex - metabolism ; Complement Membrane Attack Complex - pharmacology ; Complications ; Conditioning ; Coronary artery ; Coronary vessels ; Creatine ; Creatine kinase ; Electrocardiography ; Female ; Filtration ; Filtration - methods ; Health risks ; Heart ; Hemoperfusion ; Humans ; In Vitro Techniques ; Indication ; Integration ; Ischemia ; Lesions ; Leukapheresis ; Leukocytes ; Leukocytes (neutrophilic) ; Lymph ; Male ; Membrane attack complex ; Middle Aged ; Myocardial infarction ; Myocardial Infarction - blood ; Myocardial Infarction - physiopathology ; Myocardial Infarction - surgery ; Myocardium ; Pilot Projects ; Plateletpheresis ; Platelets ; Prospective Studies ; Rabbits ; Reperfusion ; Reperfusion - methods ; Reperfusion Injury - etiology ; Reperfusion Injury - prevention &amp; control ; Stroke Volume ; Ventricle ; Ventricular Function, Left</subject><ispartof>Perfusion, 2001-03, Vol.16 (1_suppl), p.39-49</ispartof><rights>Copyright Sage Publications Ltd. Jan 2001</rights><rights>2001 SAGE Publications</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c397t-5dbaa4354abdb237f80e07a8b357ea9c3d81822315342aedbb0855ac8d193a5a3</citedby><cites>FETCH-LOGICAL-c397t-5dbaa4354abdb237f80e07a8b357ea9c3d81822315342aedbb0855ac8d193a5a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27903,27904,79110</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/11334205$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Patel, Mrugesh B</creatorcontrib><creatorcontrib>Kilgore, Kenneth S</creatorcontrib><creatorcontrib>Ortolano, Girolamo A</creatorcontrib><creatorcontrib>Gryboski, Cyndy L</creatorcontrib><creatorcontrib>Qureshi, Mansoor A</creatorcontrib><creatorcontrib>Marcovitz, Pamela</creatorcontrib><creatorcontrib>Naylor, Keith B</creatorcontrib><creatorcontrib>Park, James L</creatorcontrib><creatorcontrib>Wenz, Barry</creatorcontrib><creatorcontrib>Gikakis, Nicolas</creatorcontrib><creatorcontrib>Freedman, Robert J</creatorcontrib><creatorcontrib>Lucchesi, Benedict R</creatorcontrib><creatorcontrib>O’Neill, William W</creatorcontrib><title>Conditioned blood reperfusion during angioplasty (CoBRA) treatment of acute myocardial infarction</title><title>Perfusion</title><addtitle>Perfusion</addtitle><description>Acute myocardial infarct (MI) results in ischemia distal to lesions which puts heart muscle at risk for reperfusion injury (RI). Neutrophils, platelets and complement are putative mediators of RI. Recent advances in filtration technology provide integrated neutrophil and platelet removal together with complement-attenuating properties in a single blood-conditioning device. The present study characterizes the properties of a blood-conditioning filter and describes its clinical effect when used in conjunction with active hemoperfusion for acute MI.The filter reduces leukocytes by 99.9998 ± 0.0002% (p&lt;0.0001) and platelets by 99.9934 ± 0.0069% (p&lt;0.0001). Human plasma, derived from heparinized blood that was ‘conditioned’ by filtration, was studied using the Langendorff isolated rabbit heart preparation. The deposition of membrane attack complex and the resultant functional myocardial impairments [reflected in hemodynamic and biochemical measurements, including developed pressure, coronary blood flow, lymph-derived myocardial creatine kinase (CK)] are significantly attenuated by blood conditioning. Integration of the blood-conditioning filter into an active hemoperfusion system during primary percutaneous transluminal coronary angioplasty (PTCA) for acute MI (n=8) did not delay the procedure or cause any complications. Reperfusion of occluded coronary arteries with 300 cm3 of conditioned blood led to significant improvement in echocardiographic global wall motion scores (in standard deviations) following treatment (1.64 ± 0.18 to 1.45 ± 0.15, p=0.02).Initial reperfusion of totally occluded coronary arteries with conditioned blood leads to acutely improved ventricular function. 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Neutrophils, platelets and complement are putative mediators of RI. Recent advances in filtration technology provide integrated neutrophil and platelet removal together with complement-attenuating properties in a single blood-conditioning device. The present study characterizes the properties of a blood-conditioning filter and describes its clinical effect when used in conjunction with active hemoperfusion for acute MI.The filter reduces leukocytes by 99.9998 ± 0.0002% (p&lt;0.0001) and platelets by 99.9934 ± 0.0069% (p&lt;0.0001). Human plasma, derived from heparinized blood that was ‘conditioned’ by filtration, was studied using the Langendorff isolated rabbit heart preparation. The deposition of membrane attack complex and the resultant functional myocardial impairments [reflected in hemodynamic and biochemical measurements, including developed pressure, coronary blood flow, lymph-derived myocardial creatine kinase (CK)] are significantly attenuated by blood conditioning. Integration of the blood-conditioning filter into an active hemoperfusion system during primary percutaneous transluminal coronary angioplasty (PTCA) for acute MI (n=8) did not delay the procedure or cause any complications. Reperfusion of occluded coronary arteries with 300 cm3 of conditioned blood led to significant improvement in echocardiographic global wall motion scores (in standard deviations) following treatment (1.64 ± 0.18 to 1.45 ± 0.15, p=0.02).Initial reperfusion of totally occluded coronary arteries with conditioned blood leads to acutely improved ventricular function. Collectively, these data provide a strong indication for continued investigation of conditioned blood reperfusion in angioplasty following acute MI for the long-term effect upon recovery of salvagable myocardium.</abstract><cop>Thousand Oaks, CA</cop><pub>SAGE Publications</pub><pmid>11334205</pmid><doi>10.1177/026765910101600i106</doi><tpages>11</tpages></addata></record>
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subjects Adult
Aged
Aged, 80 and over
Angioplasty
Angioplasty, Balloon, Coronary - methods
Animals
Arteries
Blood flow
Blood plasma
Blood pressure
Cardiac muscle
Complement
Complement Membrane Attack Complex - metabolism
Complement Membrane Attack Complex - pharmacology
Complications
Conditioning
Coronary artery
Coronary vessels
Creatine
Creatine kinase
Electrocardiography
Female
Filtration
Filtration - methods
Health risks
Heart
Hemoperfusion
Humans
In Vitro Techniques
Indication
Integration
Ischemia
Lesions
Leukapheresis
Leukocytes
Leukocytes (neutrophilic)
Lymph
Male
Membrane attack complex
Middle Aged
Myocardial infarction
Myocardial Infarction - blood
Myocardial Infarction - physiopathology
Myocardial Infarction - surgery
Myocardium
Pilot Projects
Plateletpheresis
Platelets
Prospective Studies
Rabbits
Reperfusion
Reperfusion - methods
Reperfusion Injury - etiology
Reperfusion Injury - prevention & control
Stroke Volume
Ventricle
Ventricular Function, Left
title Conditioned blood reperfusion during angioplasty (CoBRA) treatment of acute myocardial infarction
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