Document Detail


Adenosine in cold blood cardioplegia--a placebo-controlled study.
MedLine Citation:
PMID:  22108937     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Anders Ahlsson; Claudio Sobrosa; Lennart Kaijser; Eva Jansson; Vollmer Bomfim
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2011-11-15
Journal Detail:
Title:  Interactive cardiovascular and thoracic surgery     Volume:  14     ISSN:  1569-9285     ISO Abbreviation:  Interact Cardiovasc Thorac Surg     Publication Date:  2012 Jan 
Date Detail:
Created Date:  2012-01-10     Completed Date:  2012-05-22     Revised Date:  2013-06-27    
Medline Journal Info:
Nlm Unique ID:  101158399     Medline TA:  Interact Cardiovasc Thorac Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  48-55     Citation Subset:  IM    
Affiliation:
Department of Thoracic and Cardiovascular Surgery, Örebro University Hospital, Örebro, Sweden. anders.ahlsson@orebroll.se
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MeSH Terms
Descriptor/Qualifier:
Adenine Nucleotides / metabolism
Adenosine / administration & dosage*
Aged
Biopsy
Cold Temperature*
Dose-Response Relationship, Drug
Double-Blind Method
Female
Heart Arrest, Induced / methods*
Heart Valve Diseases / surgery*
Heart Valve Prosthesis Implantation / methods*
Humans
Intraoperative Complications / metabolism,  prevention & control*
Lactic Acid / metabolism
Male
Myocardial Reperfusion Injury / metabolism,  prevention & control*
Myocardium / metabolism
Oxygen Consumption
Prospective Studies
Treatment Outcome
Vasodilator Agents / administration & dosage
Chemical
Reg. No./Substance:
0/Adenine Nucleotides; 0/Vasodilator Agents; 50-21-5/Lactic Acid; 58-61-7/Adenosine
Comments/Corrections

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