AmSECT Staff
A Randomized Controlled Trial of Intra-Aortic Adenosine Infusion Before Release of the Aortic Cross-Clamp During Coronary Artery Bypass Surgery
Objectives
To assess the feasibility, safety, and potential useful effect of adenosine as a postconditioning agent in patients undergoing coronary artery bypass grafting surgeries.
Design
Prospective randomized controlled study.
Setting
University hospital.
Participants
The study comprised 60 patients scheduled for coronary artery bypass grafting surgery.
Interventions
Adenosine (postconditioning group) or placebo (control group). Adenosine infusion (150 µg/kg/min) for 10 minutes via a cardioplegia needle into the aortic root was started 10 minutes before aortic cross-clamp removal.
Measurements and Main Results
Compared with the control group, ejection fraction, fractional shortening, cardiac index (2.9 ± 0.3 v 2.2 ± 0.3 L/min/m2, p = 0.032 at 60 min postbypass) and diastolic functionindices were significantly better in the postconditioning group at most time points in the postbypass period. Cardiac troponin I and creatine kinase-MB release and the inotropicscore were significantly lower in the postconditioning group at most time points in the postoperative period. The need for intra-aortic balloon and epicardial pacing were comparable in both groups, whereas incidence of arrhythmia, duration of postoperative mechanical ventilation, and intensive care unit and total hospital stays were significantly lower in the postconditioning group.
Conclusions
Adenosine postconditioning provided cardiac protection as evidenced by a favorable outcome on systolic and diastolic function indices, less cardiac troponin I and creatine kinase-MB release, lower incidence of arrhythmia, lower inotropic score, and shorter duration of postoperative mechanical ventilation and intensive care unit stay.
