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Eur J Cardiothorac Surg 2007;32:493-500. doi:10.1016/j.ejcts.2007.05.020
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved
Department of Cardiothoracic and Vascular Surgery, University Hospital of North Norway and Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway
Received 28 August 2006; received in revised form 18 May 2007; accepted 23 May 2007.
* Corresponding author. Address: Surgical Research Laboratory, Institute of Clinical Medicine, Faculty of Medicine, University of Tromsø, 9037 Tromsø, Norway. Tel.: +47 970 63 949; fax: +47 776 28 298. (Email: oyvind.jakobsen{at}fagmed.uit.no).
Objective: To determine whether adenosine instead of supranormal potassium in cold crystalloid cardioplegia gives satisfactory cardiac arrest and improved cardioprotection. Cold crystalloid cardioplegia with adenosine, procaine and magnesium (A) was compared with standard cold crystalloid hyperkalemic cardioplegia (K). Methods: Sixteen pigs were randomized to receive either cold K (n = 8) or A (n = 8), where hyperkalemia was substituted with 1.2 mM adenosine. The cold (6 °C) cardioplegia was given intermittently and antegradely, with an aortic cross-clamp time of 1 h. Hemodynamic data was continuously measured and pressure–volume conductance catheters were used to determine global left ventricular systolic and diastolic function. Coronary flow and O2 content differences allowed determination of left ventricular energetics. Blood samples, and left ventricular microdialysis were used to measure parameters of ischemia. Measurements were done at 1 and 2 h after cross-clamp release. Results: Mean arterial pressure was reduced with 55 mmHg (standard deviation, SD: 19) in the K group versus 30 mmHg (SD: 14) in the A group 2 h after cross-clamp release (p = 0.030). Left ventricular contractility expressed as slope of the preload recruitable stroke work index (Mw) was reduced to 53% (SD: 14) in the K group versus 78% (SD: 23) in the A group 2 h after cross-clamp release (p = 0.046). Reduction of maximum of first derivate of pressure with respect to time (dP/dt max) was 804 mmHg/s (SD: 189) in the K group versus 538 mmHg/s (SD: 184) in the A group (p = 0.033). The slope of the myocardial oxygen consumption–pressure volume area was at 2 h reperfusion increased from 1.37 (SD: 0.64) to 2.86 (SD: 1.27) in the K group, whereas no shift was detected in the A group (p = 0.019). Cardiac troponin T measured in the coronary sinus 1 h after cross-clamp release was 1.25 µg/l (SD: 0.64) in the K group versus 0.73 µg/l (SD: 0.31) in the A group (p = 0.046). Conclusion: Adenosine instead of supranormal potassium in cold crystalloid cardioplegia gives satisfactory cardiac arrest, improves post cardioplegic left ventricular systolic function and efficiency, and attenuates myocardial cell damage.
Key Words: Adenosine • Cardioplegia • Energetics • Myocardial protection
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