The Effects of Cold Blood Cardioplegia with and without Adenosine on Hemodynamic Status of Patients Undergoing Mitral Valve Surgery

Abstract

Background: Minimizing ischemic-reperfusion injury following valvular heart surgeries is very important with the goal of providing appropriate cardiac systolic function, preventing arrhythmic events as well as inhibiting ischemic related processes. Due to the protective effects of adenosine, this chemical has been used as an additive to a cardioplegic solution for achieving this purpose. Objectives: The present study aimed to assess the effects of cold blood cardioplegia with adenosine on hemodynamic status of patients undergoing mitral valve surgery. Methods: This randomized single-blinded clinical trial was performed on 40 consecutive patients who were candidates for mitral valve surgery. The patients were randomly assigned to receive cold blood cardioplegia in combination with or without adenosine or hyperkalemic cardioplegia as the control. Primary endpoints were returning sinus rhythm, requiring inotropes after cardiopulmonary bypass and secondary endpoints were the change in hemodynamic parameters and postoperative complications. Results: Except for mean time required for induction of cardiac arrest that was significantly shorter in intervention group, no differences were found between the two groups regarding cardiopulmonary bypass time, cross clamp duration, and rhythm return time. In assessment of postoperative consequences, there were no differences in post-procedural events with respect to returning sinus rhythm, requiring inotropes, requiring DC shock, mean intubation time, length of ICU stay and also left ventricular systolic function. Conclusions: Except for reducing the time for inducing cardiac arrest within mitral valve surgery, adding adenosine to cold blood cardioplegia may not be beneficial regarding the improvement of postoperative outcome.

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

“…Adenosine as an adjunct to cardioplegia doesn't show an improvement in EF than without adenosine. 17 9.2±4.4 66.0±25.2sec Ghasemi 13 11.65±3.77 25.80±23.46 Jakobsen 14 11±5 sec 44±18 sec Liu 15 19.9±4.6 29.3±10.6. A study conducted by Idris on 50 consecutive patients undergoing CABG under cardiopulmonary bypass he found out that there is a difference between 12 hours postoperative period Troponin I levels between those who got adenosine and those who didn't got adenosine.…”

“…A study conducted by Ghasemi showed that in those patients who got adenosine post-operative EF is 49.75±5.95 as compared to those without adenosine is 48.50±9.04, hence concluded that there is no difference in left ventricular systolic function. 13 In A study conducted by Rinne showed that there are no differences in post-operative lactate value between those who got adenosine as compared to those who didn't have adenosine. 11 A study conducted by Ahlsson showed that there is no significant effect on lactate value in postoperative period when comparing with patient who got adenosine with those who didn't got adenosine.…”

“…11 A randomized single blinded clinical trial conducted by Ghasemi on 40 consecutive patients who were candidates for mitral valve surgery. 13 The patients were randomly assigned to receive cold blood cardioplegia in combination with or without adenosine or hyperkalemic cardioplegia as the control. Troponin I after 6 hours in patient who received adenosine is 8.41±4.84 and in control group is 10.16±6.48.…”

“…A randomized single-blinded clinical trial done by Ghasemi on 40 consecutive patients who were candidates for mitral valve surgery showed Cardiac standstill in patients with adenosine is 11.65±3.77 and those without adenosine is 25.80±23.46. 13 A study conducted by Jakobsen showed Cardiac standstill time in patient who didn't have adenosine is 44±18sec and who got adenosine is 11±5 sec. 14 A study conducted by Liu showed cardiac standstill time of 19.9±4.6 on patients who got adenosine while without adenosine cardiac standstill time is 29.3±10.6.…”

“…12 A study conducted by Ghasemi intubation time in adenosine is 504.50±157.56 minutes as compared to those who didn't got adenosine is 483.00±210.99, he concluded that there is no difference in mean intubation time when adenosine is given as an adjunct to blood cardioplegia. 13 A study conducted by Jakobsen showed extubation time in patient who didn't get adenosine was 186±103 min and who got adenosine was 169±90 min. 14 In patients who got adenosine 30 patients were shifted to ward on 3rd post-operative day,7 patients on 4th postoperative day, 2 in 5th postoperative day and 1 in 6th postoperative day.…”