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The Journal of Thoracic and Cardiovascular Surgery, Vol 98, 1057-1065, Copyright © 1989 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
T Schubert, H Vetter, P Owen, B Reichart and LH Opie
Adenosine is a potential cardioplegic agent by virtue of its specific
inhibitory properties on nodal tissue. We tested the hypothesis that
adenosine could be more effective than potassium in inducing rapid cardiac
arrest and enhancing postischemic hemodynamic recovery. Isolated rat hearts
were perfused with Krebs-Henseleit buffer or cardioplegic solutions to
determine the time to cardiac arrest and the high-energy phosphate levels
at the end of cardioplegia. Cardioplegic solutions contained adenosine 10
mmol/L, potassium 20 mmol/L, or adenosine 10 mmol/L + potassium 20 mmol/L
and were infused at a rate of 2 ml/min for 3 minutes at 10 degrees C. Both
time taken and total number of beats to cardiac arrest during 3 minutes of
cardioplegia were reduced by adenosine 10 mmol/L and adenosine 10 mmol/L +
potassium 20 mmol/L when compared with potassium 20 mmol/L alone (p less
than 0.001). Tissue phosphocreatine was conserved by adenosine 10 mmol/L
when compared with potassium 20 mmol/L, being 7.1 +/- 0.2 (mumol/gm wet
weight (n = 7) and 6.0 +/- 0.3 mumol/gm wet weight (n = 5), respectively (p
less than 0.05). Postischemic hemodynamic recovery was tested in isolated
working rat hearts. After initial cardiac arrest, the cardioplegic solution
was removed with Krebs-Henseleit buffer at a rate of 2 ml/min for 3 minutes
at 10 degrees C, and thereafter total ischemia was maintained for 30 or 90
minutes at 10 degrees C before reperfusion. Adenosine 10 mmol/L enhanced
recovery of aortic output when compared with potassium 20 mmol/L or
adenosine 10 mmol/L + potassium 20 mmol/L, the percentage recovery after 30
minutes of ischemia being 103.0% +/- 4.4% (n = 6), 89.0% +/- 5.8% (n = 6),
and 86.6% +/- 4.3% (n = 6), respectively (p less than 0.05 for comparison
between adenosine 10 mmol/L and potassium 20 mmol/L). Thus adenosine
cardioplegia caused rapid cardiac arrest and improved postischemic recovery
when compared with potassium cardioplegia and with a combination of these
two agents.
ARTICLES
Adenosine cardioplegia. Adenosine versus potassium cardioplegia: effects on cardiac arrest and postischemic recovery in the isolated rat heart
Department of Medicine, University of Cape Town, Republic of South Africa.
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S. E. Fremes, R.-K. Li, R. D. Weisel, D. A. G. Mickle, R. D. Furukawa, and L. C. Tumiati The limits of cardiac preservation with University of Wisconsin solution Ann. Thorac. Surg., October 1, 1991; 52(4): 1021 - 1025. [Abstract] [PDF]
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