The Comparison of Protective Effects of Adenosine Included Cardioplegia According to Adenosine Dosage

Yoo, Kyung Jong; Kang, Myun Sik; Lee, Kyo Joon; Lim, Sang Hyun; Park, Han Gy; Kim, Jong Hun; Cho, Bum Koo

Abstract

BACKGROUND: Adenosine is secreted by myocardial cells during myocardial ischemia or hypoxia. It has many beneficial effects on arrhythmias, myocardial ischemia, and reperfusion ischemia. Although many investigators have demonstrated that cardioplegia that includes adenosine shows protective effects in myocardial ischemia or reperfusion injury, reports of the optimal dose of adenosine in cardioplegic solutions vary. We reported the results of beneficial effects of single dosage (0.75 mg/Kg/min) adenosine by use of self-made Langendorff system. But it is uncertain that dosage was optimal. The objective of this study is to determine the optimal dose of adenosine in cardioplegic solutions. MATERIAL AND METHOD: We used a self-made Langendorff system to evaluate the myocardial protective effect. Isolated rat hearts were subjected to 90 minutes of deep hypothermic arrest (15degree C) with modified St. Thomas' Hospital cardioplegia including adenosine. Myocardial adenosine levels were augmented during ischemia by providing exogenous adenosine in the cardioplegia. Three groups of hearts were studied: (1) group 1 (n=10) : adenosine -0.5 mg/Kg/min, (2) group 2 (n=10): adenosine -0.75 mg/Kg/min, (3) group 3 (n=10) : adenosine -1 mg/Kg/min. RESULT: Group 3 resulted in a significantly rapid arrest time of the heart beat (p<0.05) but significantly slow recovery time of the heart beat after reperfusion (p<0.05) compared to groups 1 and 2. Group 2 showed a better percentage of recovery (p<0.05) in systolic aortic pressure, aortic overflow volume, coronary flow volume, and cardiac output compared to groups 1 and 3. Group 1 showed a a better percentage of recovery (p<0.05) in the heart rate compared to the others. In biochemical study of drained reperfusates, CPK and lactic acid levels did not show significant differences in all of the groups.
CONCLUSION
We concluded that group 2 [adenosine (0.75 mg/Kg/min) added to cardioplegia] has better recovery effects after reperfusion in myocardial ischemia and is the most appropriate dosage compared to group 1 and 3.