The myocardial protective effect of adenosine as an adjunct to intermittent blood cardioplegia during open heart surgery

Abstract

Compared with simple cold blood cardioplegia in heart valve replacement patients, ADO pretreatment as an adjunct to 1 mmol l(-1) ADO cold blood cardioplegia may reduce cTnI, IL-6 and IL-8 release, resulting in reduced myocardial injury in ultrastructure after surgery.

The myocardial protective effects of adenosine pretreatment in children undergoing cardiac surgery: a randomized controlled clinical trial

“…This study showed that adenosine infusion (250-350 mg kg À1 Â 10 min) just prior to cardiopulmonary bypass (CPB) resulted in immediate improvements in post-bypass cardiac index (CI) in the operation room and improved postoperative ventricular performance, lowered postoperative myocardial energy demand, and decreased myocellular injury. Similar results are reported by Wei et al [9], who pretreated patients with adenosine (total, 650 mg kg À1 via central vein infusion) before initiating CPB, and Liu et al [10], who infused adenosine (100 mg kg À1 min À1 Â 10 min) before aortic crossclamping and delivering antegrade cold-blood cardioplegia solution in patients undergoing valvular operations. Administering adenosine directly into the aortic root immediately after aortic cross-clamping and just before initiating cardioplegia can also optimize the myocardial protective effect of conventional cardioplegia and offer better postoperative myocardial performance after CPB [11,12].…”

Clinically-relevant consecutive treatment with isoproterenol and adenosine protects the failing heart against ischaemia and reperfusion

“…This was achieved using a concentration of Iso (200 nM) significantly higher than the concentration of isoproterenol in blood plasma used clinically (0.02-0.2 μg/kg/min; equivalent to about 1.3-13 nM) [6]. In contrast, the concentration of adenosine used in our experiments (30 μM) is considerably lower than that used for blood cardioplegia during cardiac surgery (1–2 mM) [7,8]. Therefore it is important to test both drugs at concentrations that are clinically relevant.…”

Potential biomarkers for predicting outcomes in CABG cardiothoracic surgeries

“…While patients are on the CPB machine, pro-inflammatory cytokines such as tumor necrosis factor alpha (TNF-α) and interleukins (IL) 1, 6 and 8 are released and mediate the systemic inflammatory response syndrome (SIRS), which is believed to play an essential role in myocardial ischemia and reperfusion injury [43]. Table 2 describes some of these and other markers.…”

“…Adenosine could be used in ischemic preconditioning (IPC) as an adjunct to cross-clamping the aorta. Compared with simple cold blood cardioplegia in heart valve replacement patients, adenosine pretreatment (100 μg/kg/min, 10 min) as an adjunct to 1 mM adenosine cold blood cardioplegia may reduce CTnI, IL-6, and IL-8 release, resulting in reduced myocardial injury after surgery [43]. The leakage of these cytokines causes post-op myocardial dysfunction and damage.…”