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J Thorac Cardiovasc Surg 2008;136:1450-1455
© 2008 The American Association for Thoracic Surgery

Cardiopulmonary Support and Physiology

The myocardial protective effects of a moderate-potassium adenosine–lidocaine cardioplegia in pediatric cardiac surgery

Zhen-Xiao Jin, MD, PhDa,*, Sheng-Li Zhang, MDa,*, Xi-Ming Wang, MDa, Sheng-Hui Bi, MDa, Mei Xin, MDa, Jing-Jun Zhou, PhDb, Qin Cui, MD, PhDa, Wei-Xun Duan, MD, PhDa, Hong-Bing Wang, MDa, Ding-Hua Yi, MD, PhDa,*

a Institute of Cardiovascular Surgery, Xijing Hospital, the Fourth Military Medical University, Xi'an, China
b Department of Physiology, the Fourth Military Medical University, Xi'an, China

Received for publication January 14, 2008; revisions received February 22, 2008; accepted for publication March 20, 2008.

* Address for reprints: Ding-Hua Yi, MD, PhD, Institute of Cardiovascular Surgery, Xijing Hospital, the Fourth Military Medical University, 17 Changle West Rd, Xi'an, China. (Email: yidinghua{at}yahoo.com.cn).

Objectives: We sought to evaluate a moderate-potassium cardioplegic solution using adenosine and lidocaine as the arresting and protecting cardioprotective combination in pediatric cardiac surgery.

Methods: One hundred thirty-four patients with congenital heart disease were randomly allocated to one of 3 groups according to the cardioplegia formula used: the high-potassium (HP) group (K+, 20 mmol/L), 46 patients; the high-potassium adenosine–lidocaine (HPAL) group (K+, 20 mmol/L; adenosine, 0.7 mmol/L; and lidocaine, 0.7 mmol/L), 44 patients; and the moderate-potassium adenosine–lidocaine (MPAL) group (K+, 10 mmol/L; adenosine, 0.7 mmol/L; and lidocaine, 0.7 mmol/L), 44 patients. Hemodynamic data during the operation and postoperative data were recorded. Serum cardiac troponin I concentrations were examined at the time points of before cardiopulmonary bypass and 1, 3, 6, 12, and 24 hours after aortic crossclamp removal.

Results: At the end of cardiopulmonary bypass and modified ultrafiltration, the systolic and pulse pressures of the MPAL group were significantly increased compared with the respective values of the HP group. At the time points of 1 to 12 hours after reperfusion, the levels of serum cardiac troponin I were significantly decreased in the MPAL group compared with those in the HP and HPAL groups.

Conclusions: The MPAL cardioplegia formula was associated with better myocardial protective effects.

Abbreviations and Acronyms AL = adenosine–lidocaine; CPB = cardiopulmonary bypass; cTnI = cardiac troponin I; HP = high potassium; HPAL = high-potassium adenosine–lidocaine; ICU = intensive care unit; MPAL = moderate-potassium adenosine–lidocaine; MUF = modified ultrafiltration; PRBC = packed red blood cell






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