HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Boehm, D. H. Articles by Reichart, B. Search for Related Content PubMed PubMed Citation Articles by Boehm, D. H. Articles by Reichart, B.

J Thorac Cardiovasc Surg 1995;110:281-282
© 1995 Mosby, Inc.

LETTERS TO THE EDITOR

The role of adenosine in University of Wisconsin solution

Department of Cardiac Surgery
University of Munich
Klinikum Grosshadern
Munich, Germany

To the Editor:

The recent article by Lasley and Mentzer ¹ investigating the role of adenosine in enhanced myocardial preservation with University of Wisconsin (UW) solution shows the important role of the compound for the protective properties of UW solution. Functional recovery as measured by rate-pressure product was significantly improved after 18 hours of cold storage with the inclusion of adenosine in UW solution. However, no difference was observed between UW solution without adenosine and St. Thomas' Hospital cardioplegic solution. The question arising is whether the inclusion of adenosine in St. Thomas' Hospital solution would have had the same beneficial effects on functional recovery and interstitial fluid purine levels. It can be concluded from the presented data that no difference exists between UW solution without adenosine and unmodified St. Thomas' Hospital solution and that the main component leading to improved preservation is adenosine.

Therefore, the conclusion drawn by the authors that the superior preservation with UW solution is a result of its intracellular-based electrolyte composition and inclusion of lactobionate, raffinose, and hydroxyethyl starch is misleading. We have shown a dose-dependent improvement of myocardial recovery with the addition of adenosine to St. Thomas' Hospital solution No. 2 in an in vivo baboon model after 3 hours of cardioplegic arrest. ² Our results, consistent with those of other studies, showed no beneficial effect on myocardial adenosine triphosphate content, stressing the fact that the effect of adenosine on improving postischemic refunction seems to be independent of its effects as an adenine nucleotide precursor.

The assumption that the low-sodium, high-potassium formulation of UW solution could presumably retard cell swelling by reducing the electrochemical gradients of these ions may be correct; however, the high potassium concentration is possibly the cause of postischemic endothelial dysfunction as a result of endothelial damage or disturbance. Amrani and colleagues ³ reported a marked increase in coronary vascular resistance associated with impaired myocardial protection when using UW solution in an isolated rat heart model for 60 minutes of global ischemia at a moderately hypothermic temperature (20º C). Loss of protection with UW solution at temperatures of 20º C compared with St. Thomas' Hospital solution No. 2 seems to be correlated with the high potassium concentrations. Other groups have also reported impaired endothelium-dependent coronary responses after cold potassium cardioplegia. ⁴

These findings show that the superior preservation with UW solution compared with other crystalloid preservation solutions is not uncontradicted. Another study from the Universities of Cape Town and Jerusalem found superior long-term preservation for 18 hours of cold storage with St. Thomas' Hospital solution No. 2 compared with UW solution in a paracorporeal porcine model. ⁵ Therefore, a study of a fourth group with St. Thomas' Hospital solution and inclusion of adenosine should be performed to substantiate the conclusions drawn by Lasley and Mentzer.

References

1. Lasley RD, Mentzer M Jr. The role of adenosine in extended myocardial preservation with the University of Wisconsin solution. J THORAC CARDIOVASC SURG 1994;107;1356-63.
   
2. Boehm DH, Human PA, von Oppell U, Owen P, Opie LH, Reichart B. Dose-dependent improvement of myocardial recovery with adenosine as an adjunct to St. Thomas' Hospital No. 2 cardioplegic solution. J Mol Cell Cardiol 1992;24(Suppl I):64-5.
   
3. Amrani M, Ledingham S, Jayakumar J, Allen NJ, Rothery S, Severs N, Yacoub M. Detrimental effects of temperature on the efficacy of the University of Wisconsin solution when used for cardioplegia at moderate hypothermia: comparison with the St. Thomas' Hospital solution at 4º C. Circulation 1992;86(Suppl 5):II280-8.
   
4. Selke FW, Shafique T, Schoen FJ, Weintraub RM. Impaired endothelium dependent coronary microvascular relaxation after cold potassium cardioplegia and reperfusion. J THORAC CARDIOVASC SURG 1993;105:52-8.[Abstract]
   
5. Worthington M, von Oppell U, Sutherland J, Human P, Schwalb H, Borman J. Comparison of myocardial preservation solutions in an 18-hour porcine paracorporeal model [Abstract]. Cardiovasc J of South Africa 1994;5(Suppl):27.
   

This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Boehm, D. H. Articles by Reichart, B. Search for Related Content PubMed PubMed Citation Articles by Boehm, D. H. Articles by Reichart, B.