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J Thorac Cardiovasc Surg 1995;110:293-301
© 1995 Mosby, Inc.

CARDIOPULMONARY BYPASS, MYOCARDIAL MANAGEMENT, AND SUPPORT TECHNIQUES

ADENOSINE PRETREATMENT FOR PROLONGED CARDIAC STORAGEAn evaluation with St. Thomas' Hospital and University of Wisconsin solutions

Toronto, Ontario, Canada

Supported in part by HSFO grant B-1959. Stephen E. Fremes is a Research Scholar of the HSFO.

Received for publication Oct. 12, 1994. Accepted for publication Jan. 19, 1995. Address for reprints: Stephen E. Fremes, MD, FRCS (C), Sunnybrook Health Science Centre, 2075 Bayview Ave.- H405, Toronto, Ontario, Canada M4N 3M5.

Abstract

Adenosine pretreatment has been shown to be beneficial in several models of ischemia-reperfusion. We wished to evaluate whether adenosine pretreatment is cardioprotective for prolonged cardiac storage and whether the presence of adenosine in the storage media affects the results. Isolated rodent hearts were obtained from Sprague-Dawley rats, mounted on a Langendorff apparatus, instrumented with an intraventricular balloon, and ventricularly paced at 300 beats/min. Four groups of hearts were studied in a 2x2 factorial experiment (n= 8 to 12 per group). Hearts were subjected to normal perfusion or to solution supplemented with adenosine 50µmol/L for 10 minutes followed by adenosine-free perfusion for 10 minutes. Hearts then were stored for 8 hours at 0º C in either University of Wisconsin solution (adenosine 5 mmol/L) or St. Thomas' Hospital II solution (adenosine free). Adenosine pretreatment increased tissue levels of adenosine triphosphate before storage (p= 0.04). Nonfunction was less common after storage (1/19 versus 6/20 hearts, p< 0.05), and diastolic function was better preserved in the adenosine groups in the reperfusion phase (p= 0.01). The beneficial effects of adenosine pretreatment were independent of which storage solution was used. Developed pressure was increased (p< 0.05) and release of creatine kinase and lactate dehydrogenase was reduced (p< 0.0001) in hearts treated with University of Wisconsin solution compared with those treated with St. Thomas' Hospital solution. These studies suggest that adenosine pretreatment improves recovery after prolonged hypothermic storage and that the presence of adenosine in the preservation solution does not alter the results. The experiments provide further evidence that extended myocardial protection is better enhanced with University of Wisconsin solution than with St. Thomas' Hospital II solution. (J THORACCARDIOVASCSURG1995;110:293-301)

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