The Effects of Cold Blood Cardioplegia with and without Adenosine on Hemodynamic Status of Patients Undergoing Mitral Valve Surgery

Background: Minimizing ischemic-reperfusion injury following valvular heart surgeries is very important with the goal of providing appropriate cardiac systolic function, preventing arrhythmic events as well as inhibiting ischemic related processes. Due to the protective effects of adenosine, this chemical has been used as an additive to a cardioplegic solution for achieving this purpose. Objectives: The present study aimed to assess the effects of cold blood cardioplegia with adenosine on hemodynamic status of patients undergoing mitral valve surgery. Methods: This randomized single-blinded clinical trial was performed on 40 consecutive patients who were candidates for mitral valve surgery. The patients were randomly assigned to receive cold blood cardioplegia in combination with or without adenosine or hyperkalemic cardioplegia as the control. Primary endpoints were returning sinus rhythm, requiring inotropes after cardiopulmonary bypass and secondary endpoints were the change in hemodynamic parameters and postoperative complications. Results: Except for mean time required for induction of cardiac arrest that was significantly shorter in intervention group, no differences were found between the two groups regarding cardiopulmonary bypass time, cross clamp duration, and rhythm return time. In assessment of postoperative consequences, there were no differences in post-procedural events with respect to returning sinus rhythm, requiring inotropes, requiring DC shock, mean intubation time, length of ICU stay and also left ventricular systolic function. Conclusions: Except for reducing the time for inducing cardiac arrest within mitral valve surgery, adding adenosine to cold blood cardioplegia may not be beneficial regarding the improvement of postoperative outcome.