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Adenosine in cold blood cardioplegia: a placebo-controlled study
Department of Thoracic and Cardiovascular Surgery, Örebro University Hospital, Örebro, Sweden.ORCID iD: 0000-0002-6913-0669
Department of Thoracic and Cardiovascular Surgery, Örebro University Hospital, Örebro, Sweden.
Division of Clinical Physiology and Department of Laboratory Medicine, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.
Division of Clinical Physiology and Department of Laboratory Medicine, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.
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2012 (English)In: Interactive Cardiovascular and Thoracic Surgery, ISSN 1569-9293, E-ISSN 1569-9285, Vol. 14, no 1, p. 48-55Article in journal (Refereed) Published
Abstract [en]

Objective: Adenosine as an additive in blood cardioplegia is cardioprotective in animal studies, but its clinical role in myocardial protection remains controversial. The aim of this study was to investigate whether the addition of adenosine in continuous cold blood cardioplegia would enhance myocardial protection.

Methods: In a prospective double-blind study comparing adenosine 400 μmol l(-1) to placebo in continuous cold blood cardioplegia, 80 patients undergoing isolated aortic valve replacement were randomized into four groups: antegrade cardioplegia with adenosine (n = 19), antegrade cardioplegia with placebo (n = 21), retrograde cardioplegia with adenosine (n = 21) and retrograde cardioplegia with placebo (n = 19). Myocardial arteriovenous differences in oxygen and lactate were measured before, during and after aortic occlusion. Myocardial concentrations of adenine nucleotides and lactate were determined from left ventricular biopsies obtained before aortic occlusion, after bolus cardioplegia, at 60 min of aortic occlusion and at 20 min after aortic occlusion. Plasma creatine kinase (CK-MB) and troponin T were measured at 1, 3, 6, 9, 12 and 24 h after aortic occlusion. Haemodynamic profiles were obtained before surgery and 1, 8 and 24 h after cardiopulmonary bypass. Repeated-measures analysis of variance was used for significance testing.

Results: Adenosine had no effects on myocardial metabolism of oxygen, lactate and adenine nucleotides, postoperative enzyme release or haemodynamic performance. When compared with the antegrade groups, the retrograde groups showed higher myocardial oxygen uptake (17.3 ± 11.4 versus 2.5 ± 3.6 ml l(-1) at 60 min of aortic occlusion, P < 0.001) and lactate accumulation (43.1 ± 20.7 versus 36.3 ± 23.0 µmol g(-1) at 60 min of aortic occlusion, P = 0.052) in the myocardium during aortic occlusion, and lower postoperative left ventricular stroke work index (27.2 ± 8.4 versus 30.1 ± 7.9 g m m(-2), P = 0.034).

Conclusions: Adenosine 400 μmol l(-1) in cold blood cardioplegia showed no cardioprotective effects on the parameters studied. Myocardial ischaemia was more pronounced in patients receiving retrograde cardioplegia.

Place, publisher, year, edition, pages
Oxford, United Kingdom: Oxford University Press, 2012. Vol. 14, no 1, p. 48-55
Keywords [en]
Myocardial biopsy, circulatory haemodynamics, coronary sinus, myocardial protection, myocardial metabolism
National Category
Surgery
Research subject
Surgery
Identifiers
URN: urn:nbn:se:oru:diva-27318DOI: 10.1093/icvts/ivr027ISI: 000310174000014PubMedID: 22108937Scopus ID: 2-s2.0-84861317286OAI: oai:DiVA.org:oru-27318DiVA, id: diva2:603247
Available from: 2013-02-05 Created: 2013-02-05 Last updated: 2017-12-06Bibliographically approved

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