Fast Induction of Myocardial Arrest by Bolus Injection of Adenosine at Aortic Root in Patients with “sick heart” Undergoing Cardiac Surgery Enhances Myocardial Protection

Dr Jyoti Prasad Kalita; Prof Manuj Kumar saikia; Prof A G Ahangar; Dr Md Yunus; Dr Samarjit Dey; Dr Amit Malviya; Dr Manish Kapoor; Prof Animesh Mishra; Dr Pravin Jha; Dr Chandra Kumar Das

Volume : V, Issue : VIII, August - 2016

Fast Induction of Myocardial Arrest by Bolus Injection of Adenosine at Aortic Root in Patients with “sick heart” Undergoing Cardiac Surgery Enhances Myocardial Protection

Dr Jyoti Prasad Kalita, Prof Manuj Kumar Saikia, Prof A G Ahangar, Dr Md Yunus, Dr Samarjit Dey, Dr Amit Malviya, Dr Manish Kapoor, Prof Animesh Mishra, Dr Pravin Jha, Dr Chandra Kumar Das

Abstract :

 Fast Induction of Myocardial Arrest by Bolus Injection of Adenosine at Aortic Root in Patients with “sick heart” Undergoing Cardiac Surgery Enhances Myocardial Protection Objective Adenosine is an endogenous purine nucleoside and a well known potent vasodilator. Adenosine pretreatment reduces the injury caused by ischemia–reperfusion of heart. The purpose of this study is to investigate that whether the aortic root administration of adenosine as bolus dose followed by routine cardioplegia after aortic cross–clamping has additional myocardial protection in cardiac surgical patients with “sick hearts” undergoing cardiac valve surgery under cardiopulmonary bypass. Method: Patients of 20 to 40 years old who underwent mitral valve replacement under cardiopulmonary bypass for severe mitral regurgitation with ejection fraction (EF) of 35 to 45% were included in this study. In all patients Medtronic ATS valve was put after complete preservation of submitral apparatus. Twenty patients (Group A) were to receive adenosine solution (250 microg/kg) injection at aortic root followed by modified St. Thomas cardioplegic (20 mL/kg). Another twenty patients (Group B) to receive modified St. Thomas cardioplegic (20 mL/kg) alone. The anesthetic management was similar and surgeries were performed by the same team. The haemodynamic change, cardiac enzyme – Serum troponin I assay, post–bypass inotropic supplementation and total period of intensive care unit stay were recorded throughout the study period to evaluate the extent of myocardial ischemic injury. Results: The mean time was taken to have cardiac asystole after aortic cross–clamping was significantly shorter for Group A compared to the Group B (9.2 +/– 4.4 vs. 66.0 +/– 25.2 sec, respectively; P< 0.01). To compare with the baseline value, the mean cardiac index immediately post CPB and 24 hours postoperatively was increased significantly for the adenosine group (from 1.8 +/– 0.4 to 2.0 +/– 0.3 and 2.3+/– 0.4 L/min/m2, respectively; P < 0.05), as contrasted with the control group (from 1.8 +/– 0.5 to 1.9 +/– 0.4 and 2.1 +/– 0.4 L/min/ m2). Postoperative levels of serum troponin I was greater in Group B then Group A. Further, the requirement for inotropic support after CPB and postoperative serum troponin I release were significantly less in Group A. The ICU stay was significantly shorter in adenosine pretreatment group compared to the control group (3.2 ± 1.2 days vs 3.9 ± 1.2 days, p = 0.013). There were no adverse affects associated with adenosine administration. Conclusions:This study demonstrates that immediate administration of adenosine via the aortic root following aortic cross–clamping followed by conventional cardioplegia quicken cardiac standstill, protective of the myocardium, and offer better postoperative myocardial performance during open–heart surgery in patients with left ventricular dysfunction.