Intracoronary hypothermia for acute myocardial infarction in the isolated beating pig heart

Hypothermia may attenuate reperfusion injury and thereby improve acute myocardial infarction therapy. Systemic cooling trials failed to reduce infarct size, perhaps because the target temperature was not reached fast enough. The use of selective intracoronary hypothermia combined with intracoronary temperature monitoring allows for titrating to target temperature and optimizing the cooling rate. We aimed to the test the feasibility of intracoronary cooling for controlled, selective myocardial hypothermia in an isolated beating pig heart. In five porcine hearts the left anterior descending artery (LAD) was occluded by an over-the-wire balloon (OTWB). After occlusion, saline at 22 degrees C was infused through the OTWB lumen for 5 minutes into the infarct area at a rate of 30 ml/min. Thereafter the balloon was deflated but infusion continued with saline at 4 degrees C for 5 minutes. Distal coronary temperature was continuously monitored by a pressure/temperature guidewire. Myocardial temperature at several locations in the infarct and control areas was recorded using needle thermistors. In the occlusion phase, coronary temperature decreased by 11.4 degrees C (range 9.4-12.5 degrees C). Myocardial temperature throughout the infarct area decreased by 5.1 degrees C (range 1.8-8.1 degrees C) within three minutes. During the reperfusion phase, coronary temperature decreased by 6.2 degrees C (range 4.1-10.3 degrees C) and myocardial temperature decreased by 4.5 degrees C (range 1.5-7.4 degrees C). Myocardial temperature outside the infarct area was not affected. In the isolated beating pig heart with acute occlusion of the LAD, we were able to rapidly "induce, maintain, and control" a stable intracoronary and myocardial target temperature of at least 4 degrees C below body temperature without side effects and using standard PCI equipment, justifying further studies of this technique in humans.