Reperfusion injury from a hemodynamic standpoint and role of pressure-controlled reperfusion in avoiding reperfusion injury
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2026
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Abstract
Abstract Currently, there is no established treatment for post-ischemic reperfusion-related injury, namely reperfusion injury (RI), which paradoxically exacerbates microvascular and tissue damage in any reperfused ischemic organ territory. During the ischemic phase, the autoregulatory apparatus in a subtended organ region temporarily loses its pressure-regulating function because of the combined effects of drastically increased oxygen demand and ischemic insult. Therefore, it cannot protect the hypoxically injured distal capillary bed from the detrimental effect of the sudden and uncontrolled pressure rise that occurs during the initial phase of reperfusion. This acute capillary barotrauma caused by abruptly initiated reperfusion at systemic pressure can be regarded as an iatrogenic trigger for subsequent damage in the reperfused organ territory. From this hemodynamic perspective, RI can be redefined as ‘capillary hyperpressurization syndrome’, dictated by the ‘initial reperfusion pressure’. Accordingly, initiating reperfusion gently at lower pressures [pressure-controlled reperfusion: PCR] and maintaining it at that level until protective autoregulatory myogenic control mechanisms recover may provide substantial benefit in limiting the progressive damage caused by post-ischemic abrupt and full-pressure reperfusion. In this review, we revisit RI from this hemodynamic perspective and suggest that the same pathomechanism—namely, acute exposure of ischemically injured microvascular endothelium to an uncontrolled pressure rise during the initial reperfusion phase—predominantly dictates post-reperfusion damage in the heart and in other organ ischemia-reperfusion settings, where PCR techniques may help limit post-reperfusion damage.
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| Authors | Murat Sezer, Ahmet Taş, Yaren Alan, Ilke Kara Tas, Alp Ozcan, D Perera, Irem Sezer, Sayan Sen, Jan J Piek, Sabahattin Umman |
| Journal | European Heart Journal Open |
| Year | 2026 |
| DOI |
10.1093/ehjopen/oeag098
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| URL | |
| Keywords | Keywords not found |
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