Shinya Kanemoto, MD, Muneaki Matsubara, MD, Mio Noma, MD, Bradley G

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Mild Hypothermia to Limit Myocardial Ischemia-Reperfusion Injury: Importance of Timing Shinya Kanemoto, MD, Muneaki Matsubara, MD, Mio Noma, MD, Bradley G. Leshnower, MD, Landi M. Parish, MD, Benjamin M. Jackson, MD, Robin Hinmon, MS, Hirotsugu Hamamoto, MD, Joseph H. Gorman, MD, Robert C. Gorman, MD The Annals of Thoracic Surgery Volume 87, Issue 1, Pages 157-163 (January 2009) DOI: 10.1016/j.athoracsur.2008.08.012 Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Protocol schematic demonstrating when cooling was initiated in each group. Initial temperature was recorded rectally at the induction of anesthesia. Baseline and all other temperatures were recorded in the left atrium after the chest was opened. (— = normothermia; ··· = hypothermia; C = cooling.) The Annals of Thoracic Surgery 2009 87, 157-163DOI: (10.1016/j.athoracsur.2008.08.012) Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Time course of the core temperature change for each experimental group. Initial temperature was recorded rectally at the induction of anesthesia. Baseline and all other temperatures were recorded in the left atrium after the chest was opened. (—●— = W-W-W; —○— = C-C-C; —▾— = W-C0-C; —▿— = W-C15-C; —■— = W-C25-C; —□— = W-W-C.) The Annals of Thoracic Surgery 2009 87, 157-163DOI: (10.1016/j.athoracsur.2008.08.012) Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 (A) Area at risk as a percentage of the left ventricular (LV) mass for all experimental groups (mean ± SEM). (B) Infarct size as a percentage of the area at risk (AR) for all experimental groups (mean ± SEM). (ap < 0.05 vs W-W-W; bp < 0.05 vs W-W-C.) The Annals of Thoracic Surgery 2009 87, 157-163DOI: (10.1016/j.athoracsur.2008.08.012) Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Plot of the correlation between left atrial (LA) temperature and infarct size during ischemia and reperfusion. Temperature during late ischemia and early reperfusion correlate most strongly with infarct size. (AR = area at risk; I = infarct.) The Annals of Thoracic Surgery 2009 87, 157-163DOI: (10.1016/j.athoracsur.2008.08.012) Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Plot of infarct size versus temperature at the time of reperfusion for all animals in all groups. (AR = area at risk.) The Annals of Thoracic Surgery 2009 87, 157-163DOI: (10.1016/j.athoracsur.2008.08.012) Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions