Comparison of troponin 1 level among the patients who underwent coronary artery bypass grafting with and without adenosine as an adjunct to blood cardioplegia

Abstract

Background: Cellular injury is not avoidable with current cardioplegic solutions. No method of cardioplegia has been shown to completely protect the myocardium against cellular injury. The objective of the study is to evaluate the safety and efficacy of adenosine as an adjunct to blood cardioplegia during CABG.Methods: A retrospective study at GMCT, Thiruvananthapuram in CABG patients for 3 years from January 1, 2016, to December 31, 2019, between the age of 40 and 70 years. Patients with other chronic diseases and pre-operative echo showing EF less than 40% were excluded. The study variables were level of troponin I intra and postoperative period, time taken for cardiac standstill, number of days in ventilator, ICU and on inotropic supports. Also, postoperative lactate levels, changes in RWMA and EF.Results: Of the total 75 subjects, 40 got adenosine while 35 didn’t. The mean post op EF for those who got adenosine is 55.30 and without is 56.46. The mean time of cardiac stand still with adenosine is 12.88 sec and without is 16.51 sec. The mean post op troponin I level in those who got adenosine is 6.43 and without is 12.94.Conclusions: Decreased level of troponin I and inotropic requirement suggests that an optimal myocardial protection. Adenosine usage helps in early extubation but doesn’t alter the number of days in ICU. Adenosine is safe, gives more rapid cardiac arrest but it will not alter the post op left ventricular function.