Iranian Heart Journal

Iranian Heart Journal

Impact of Adenosine Injection on the Clinical Outcome and Myocardial Protection in Patients Undergoing Coronary Artery Bypass Graft Surgery

Document Type : Original Article

Authors
Farshad Jalili Shahandashti 1
Mina Memarjafari 1
Rasoul Azarfarin 1
Yaser Toloueitabar 1
Sanaz Asadian 1
Amirhosein Jalali 1
Naser Kachoueian 2
Farhad Gorjipour 1
1 Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
2 Department of cardiac surgery, Imam Hossein Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran.
Abstract
Background: Cellular damage is inevitable during cardiac surgery due to cardioplegic solutions and subsequent ischemia-reperfusion injury. There are controversies regarding the cardioprotective impact of adenosine addition to cardioplegic solutions in patients undergoing coronary artery bypass graft surgery (CABG). We aimed to assess the impact of adding adenosine to antegrade cardioplegia and before aortic declamping to the aortic root on the clinical outcomes of patients undergoing CABG.
 
Methods: The present single-blinded randomized clinical trial was performed on 99 patients of both sexes undergoing isolated CABG. The patients were randomly allocated to 2 trial groups and 1 control group: Group A, adenosine injection with antegrade cardioplegia (n=30); Group B, adenosine injection before aortic declamping by the surgeon at the aortic root (n=26); and Group C, control (n=30). In the course of the study, 13 participants lost their eligibility according to exclusion criteria. The patients’ plasma creatine kinase (CK-MB), troponin T, lactate, and clinical outcomes were measured as trial outcomes.
 
Results: The frequency of patients with antiarrhythmic drug usage was significantly lower in trial groups A and B than in the control group (P = 0.001). The cardiac rhythm resumption time was significantly longer in the control group (344.37 ± 260.45) than in Group A (193.43 ± 297.73) and Group B (170.12 ± 103.58) (P = 0.02). Adenosine injection before aortic declamping (Group B) had the lowest time of cardiac rhythm resumption between the trial groups.
 
Conclusions: Our findings showed that adenosine injection enhanced the efficacy of cardioplegic arrest and myocardial protection during CABG. (Iranian Heart Journal 2023; 24(4): 26-33)
Keywords
Adenosine
Cardiac arrhythmias
Cardiac function
CABG
  1. Abdelwahab AA, Sabry M, Elshora HA, Arafat AA. Effect of Fast Cardioplegic Arrest Induced by Adenosine on Cardiac Troponin Levels After Heart Valve Surgery. Heart, Lung and Circulation. 2019; 28(11):1714-9.
  2. 2. Randhawa PK, Bali A, Virdi JK, Jaggi AS. Conditioning-induced cardioprotection: Aging as a confounding factor. The Korean Journal of Physiology & Pharmacology. 2018; 22(5):467-79.
  3. 3. Montrief T, Koyfman A, Long B. Coronary artery bypass graft surgery complications: A review for emergency clinicians. Am J Emerg Med. 2018; 36(12):2289-97.
  4. 4. Tabaei AS, Mortazian M, Yaghoubi A, Gorjipour F, Manesh SA, Totonchi Z, et al. Modified ultrafiltration in coronary artery bypass grafting: a randomized, double-blinded, controlled clinical trial. Iran Red Crescent Med J. 2018; 20:e66187.
  5. Gorjipour F, Saeedzadeh T, Toloueitabar Y, Kachoueian N, Bahlouli Ghashghaei S, Mortazian M, et al. Remote ischemic preconditioning effects on inflammatory markers and myocardial protection in coronary artery bypass graft surgery. Perfusion. 2022; 37(1):56-61.
  6. Filardo G, Ailawadi G, Pollock BD, da Graca B, Phan TK, Thourani V, et al. Postoperative atrial fibrillation: Sex-specific characteristics and effect on survival. J Thorac Cardiovasc Surg. 2020; 159(4):1419-25 e1.
  7. Hashemi J, Ghaffari Nejad M, Baharestani B, . Esfandiari R, Panahipoor A. Evaluation and comparison of use of low-dose aprotinin and tranexamic acid in cabg: a double–blind, prospective, randomized study of 150 patients. Iranian Heart Journal. 2011; 12(1):40-4.
  8. 8. Filardo G, Ailawadi G, Pollock BD, da Graca B, Phan TK, Thourani V, et al. Postoperative atrial fibrillation: Sex-specific characteristics and effect on survival. J Thorac Cardiovasc Surg. 2020; 159(4):1419-25 e1.
  9. 9. Iguina MM, Smithson S, Danckers M. Incessant Refractory Polymorphic Ventricular Tachycardia After Coronary Artery Bypass Graft. Cureus. 2021; 13(1):e12752.
  10. 10. Cayir MC, Yuksel A. The use of del Nido cardioplegia for myocardial protection in isolated coronary artery bypass surgery. Heart, Lung and Circulation. 2020; 29(2):301-7.
  11. 11. Li Y, Lin H, Zhao Y, Li Z, Liu D, Wu X, et al. Del Nido cardioplegia for myocardial protection in adult cardiac surgery: a systematic review and meta-analysis. Asaio Journal. 2018; 64(3):360-7.
  12. 12. Nardi P, Pisano C, Bertoldo F, Vacirca SR, Saitto G, Costantino A, et al. Warm blood cardioplegia versus cold crystalloid cardioplegia for myocardial protection during coronary artery bypass grafting surgery. Cell death discovery. 2018; 4(1):1-6.
  13. 13. Gholampour Dehaki M, Gorjipour F, Gorjipour F, Mahdavi M, Kachoueian N, Heidarynia S. The effect of Del Nido versus custodiol cardioplegia on clinical outcomes and troponin-I changes among pediatrics with tetralogy of fallot undergoing cardiopulmonary bypass. Perfusion. 2022:02676591221141791.
  14. 14. Li Y, Hu X-X, Fu L, Chen J, Lu L-h, Liu X, et al. Time window is important for adenosine preventing cold-induced injury to the endothelium. Journal of cardiovascular pharmacology. 2017; 69(6):382-8.
  15. 15. Ammar A, Mahmoud K, Elkersh A, Kasemy Z. A Randomized Controlled Trial of Intra-Aortic Adenosine Infusion Before Release of the Aortic Cross-Clamp During Coronary Artery Bypass Surgery. Journal of cardiothoracic and vascular anesthesia. 2018; 32(6):2520-7.
  16. 16. Beyersdorf F. Intraoperative myocardial protection: still the cornerstone of cardiac surgery. European Journal of Cardio-Thoracic Surgery. 2021.
  17. 17. Mentzer Jr RM, Rahko PS, Molina-Viamonte V, Canver CC, Chopra PS, Love RB, et al. Safety, tolerance, and efficacy of adenosine as an additive to blood cardioplegia in humans during coronary artery bypass surgery. The American journal of cardiology. 1997; 79(12):38-43.
  18. 18. Chen C-H, Kang P-L, Chang T-H, Lo A, Ye X-D, Lee M-C, et al. Bolus injection of adenosine before cardioplegic induction improves postischemic global function in coronary artery bypass grafting. Acta anaesthesiologica Taiwanica: official journal of the Taiwan Society of Anesthesiologists. 2005;43(4):197-204.
  19. 19. Idris MR, Quashem M, Hasan MK, Karim MR. Effect of Adenosine on Myocardial Protection as an Adjunct to Cardioplegia during Coronary Artery Bypass Surgery. University Heart Journal. 2018; 14(1):21-3.
  20. 20. Shalaby A, Rinne T, Järvinen O, Saraste A, Laurikka J, Porkkala H, et al. Initial results of a clinical study: adenosine enhanced cardioprotection and its effect on cardiomyocytes apoptosis during coronary artery bypass grafting. European journal of cardio-thoracic surgery. 2008; 33(4):639-44.
  21. 21. Ghasemi F, Azarfarin R, Salahi S, Baharestani B, Alizadeh Ghavidel A. The Effects of Cold Blood Cardioplegia with and without Adenosine on Hemodynamic Status of Patients Undergoing Mitral Valve Surgery. Multidisciplinary Cardiovascular Annals. 2020;11(1).
  22. 22. Malhotra A, Wadhawa V, Ramani J, Garg P, Sharma P, Pandya H, et al. Normokalemic nondepolarizing long-acting blood cardioplegia. Asian Cardiovasc Thorac Ann. 2017; 25(7-8):495-501.
  23. 23. Jakobsen O, Naesheim T, Aas KN, Sorlie D, Steensrud T. Adenosine instead of supranormal potassium in cardioplegia: it is safe, efficient, and reduces the incidence of postoperative atrial fibrillation. A randomized clinical trial. J Thorac Cardiovasc Surg. 2013; 145(3):812-8.
  24. 24. Ahlsson A, Sobrosa C, Kaijser L, Jansson E, Bomfim V. Adenosine in cold blood cardioplegia–a placebo-controlled study. Interactive cardiovascular and thoracic surgery. 2012; 14(1):48-55.
Iranian Heart Journal
Volume 24, Issue 4
Autumn 2023
Pages 26-33