The Journal of Thoracic and Cardiovascular Surgery
Volume 139, Issue 6 , Pages 1576-1586 , June 2010

Normokalemic adenosine–lidocaine cardioplegia: Importance of maintaining a polarized myocardium for optimal arrest and reanimation

  • Kathryn L. Sloots, BSc (Hons)
  • ,
  • Geoffrey P. Dobson, PhD

      Affiliations

    • Corresponding Author InformationAddress for reprints: Geoffrey P. Dobson, PhD, Department of Physiology and Pharmacology, Molecular Science Building, James Cook University, Townsville, Queensland 4811, Australia.

Received 16 July 2009 ,Revised 18 September 2009 ,Accepted 4 October 2009.

References 

  1. Maganti M, Rao V, Armstrong S, Feindel CM, Scully HE, David TE. Redo valvular surgery in elderly patients. Ann Thorac Surg. 2009;87:521–525
  2. Cohen NM, Damiano RJ, Wechsler AS. Is there an alternative to potassium arrest?. Ann Thorac Surg. 1995;60:858–863
  3. Allen BS. Pediatric myocardial protection: where do we stand?. J Thorac Cardiovasc Surg. 2004;128:11–13
  4. Snabaitis AK, Shattock MJ, Chambers DJ. Comparison of polarized and depolarized arrest in the isolated rat heart for long-term preservation. Circulation. 1997;96:3148–3156
  5. Chambers DJ, Hearse DJ. Cardioplegia and surgical ischaemia. In:  Sperelakis N,  Kurachi Y,  Terzic A,  Cohen MV editor. Heart physiology and pathophysiology. San Diego: Academic Press; 2001;p. 887–926
  6. Dobson GP. Organ arrest, protection and preservation: natural hibernation to cardiac surgery: a review. Comp Biochem Physiol Part B. 2004;139:469–485
  7. Sloots K, Vinten-Johansen J, Dobson GP. Warm non-depolarising adenosine-lidocaine cardioplegia: continuous versus intermittent delivery. J Thorac Cardiovasc Surg. 2007;133:1171–1178
  8. Rudd DM, Dobson GP. Towards a new cold and warm non-depolarising, normokalemic arrest paradigm for orthotopic heart transplantation. J Thorac Cardiovasc Surg. 2009;137:198–207
  9. Ruel M, Khan TA, Voisine P, Bianchi C, Sellke FW. Vasomotor dysfunction after cardiac surgery. Eur J Cardiothorac Surg. 2004;26:1002–1014
  10. Ellis RJ, Mavroudis C, Gardner C, Turley K, Ullyot D, Ebert PA. Relationship between atrioventricular arrhythmias and the concentration of K+ ion in cardioplegic solution. J Thorac Cardiovasc Surg. 1980;80:517–526
  11. Spinale FG. Cellular and molecular therapeutics targets for treatment of contractile dysfunction after cardioplegic arrest. Ann Thorac Surg. 1999;68:1934–1941
  12. Dobson GP, Jones MW. Adenosine and lignocaine: a new concept in non-depolarising surgical arrest, protection and preservation. J Thorac Cardiovasc Surg. 2004;127:794–805
  13. Corvera JS, Kin H, Dobson GP, Kerendi F, Halkos ME, Katzmark S, et al. Polarized arrest with warm or cold adenosine/lidocaine blood cardioplegia is equivalent to hypothermic potassium blood cardioplegia. J Thorac Cardiovasc Surg. 2005;129:599–606
  14. Canyon SJ, Dobson GP. Protection against ventricular arrhythmias and cardiac death using adenosine and lidocaine during regional ischemia in the in vivo rat. Am J Physiol Heart Circ Physiol. 2004;287:H1286–H1295
  15. Homeister JW, Hoff PT, Fletcher DD, Lucchesi BR. Combined adenosine and lidocaine administration limits myocardial reperfusion injury. Circulation. 1990;82:595–608
  16. Vander Heide RS, Reimer KA. Effect of adenosine therapy at reperfusion on myocardial infarct size in dogs. Cardiovasc Res. 1996;31:711–718
  17. Mahaffey KW, Puma JA, Barbagelata NA, DiCarli MF, Leesar MA, Browne KF, et al. Adenosine as an adjunct to Thrombolytic Therapy for acute myocardial infarction. J Am Coll Cardiol. 1999;34:1711–1720
  18. Bernstein J. Untersuchungen zur thermodynamie der biolectrischen strome, erster theil. Pflugers Arch. 1902;92:521–562
  19. Masuda T, Dobson GP, Veech RL. The Gibbs-Donnan near-equilibrium system of heart. J Biol Chem. 1990;265:20321–20334
  20. Kleber AG. Resting membrane potential, extracellular potassium activity, and intracellular sodium activity during acute global ischemia in isolated perfused guinea pig hearts. Circ Res. 1983;52:442–450
  21. Wan X, Bryant SM, Hart G. The effects of [K+]o on regional differences in electrical characteristics of ventricular myocytes in guinea-pig. Exp Physiol. 2000;85:769–774
  22. Veech RL, Kashiwaya Y, King MT. The resting membrane potential of cells are measures of electrical work, not of ionic currents. Integr Physiol Behav Sci. 1995;30:283–307
  23. Lopatin AN, Nichols CG. Inward rectifiers in the heart: an update on IK1. J Mol Cell Cardiol. 2001;33:625–638
  24. Brace RA, Anderson DK, Chen WT, Scott JB, Haddy FJ. Local effects of hypokalemia on coronary resistance and myocardial contractile force. Am J Physiol. 1974;227:590–597
  25. Mankad PS, Chester AH, Yacoub MH. Role of potassium concentration in cardioplegic solutions in mediating endothelial damage. Ann Thorac Surg. 1991;51:89–93
  26. Ericsson AB, Takeshima S, Vaage J. Warm or cold continuous blood cardioplegia provides similar myocardial protection. Ann Thorac Surg. 1999;68:454–459
  27. Tyers GF, Todd GJ, Niebauer IM, Manley NJ, Waldhausen JA. The mechanism of myocardial damage following potassium citrate (Melrose) cardioplegia. Surgery. 1975;78:45–53
  28. Leicher FG, Magrassi P, LaRaia PJ, Derkac WM, Buckley MJ, Austen WG. Blood cardioplegia delivery. Deleterious effects of potassium versus lidocaine. Ann Surg. 1983;198:266–272
  29. Ozeki T, Kwon MH, Gu J, Collins MJ, Brassil J, Miller MBJ, et al. Heart preservation using continuous ex vivo perfusion improves viability and functional recovery. Circ J. 2007;71:153–159
  30. Ferguson ER, Spruell RD, Vicente WVA, Murrah CP, Holman WL. Coronary vascular regulation during post-cardioplegia reperfusion. J Thorac Cardiovasc Surg. 1996;112:1054–1063
  31. Jin ZX, Zhang SL, Wang XM, Bi SH, Xin M, Zhou JJ, et al. The myocardial protective effects of a moderate potassium adenosine–lidocaine cardioplegia in pediatric cardiac surgery. J Thorac Cardiovasc Surg. 2008;136:1450–1455
  32. O'Rullian JJ, Clayson SE, Peragallo R. Excellent outcomes in a critical redo valve replacement patient requiring ten hours of cardiopulmonary bypass and seven hours of cardioplegia using microplegia with adjunctive adenosine and lidocaine (Adenocaine™). J Extra Corpor Technol. 2008;40:203–205

 Disclosures: G. P. Dobson reports lecture fees and equity in Hibernation Therapeutics.

 Supported in part by National Heart Foundation grant G 05B 2034 (to GPD) and National Health and Medical Research grant 540409 (to GPD).

PII: S0022-5223(09)01337-3

doi: 10.1016/j.jtcvs.2009.10.013

The Journal of Thoracic and Cardiovascular Surgery
Volume 139, Issue 6 , Pages 1576-1586 , June 2010