Impact of Adenosine Injection on the Clinical Outcome and Myocardial Protection in Patients Undergoing Coronary Artery Bypass Graft Surgery

Cellular damage is inevitable during cardiac surgery due to cardioplegic solutions and subsequent ischemia-reperfusion injury. There are controversies regarding the cardioprotective impact of adenosine addition to cardioplegic solutions in patients undergoing coronary artery bypass graft surgery (CABG). We aimed to assess the impact of adding adenosine to antegrade cardioplegia and before aortic declamping to the aortic root on the clinical outcomes of patients undergoing CABG.
 
The present single-blinded randomized clinical trial was performed on 99 patients of both sexes undergoing isolated CABG. The patients were randomly allocated to 2 trial groups and 1 control group: Group A, adenosine injection with antegrade cardioplegia (n=30); Group B, adenosine injection before aortic declamping by the surgeon at the aortic root (n=26); and Group C, control (n=30). In the course of the study, 13 participants lost their eligibility according to exclusion criteria. The patients’ plasma creatine kinase (CK-MB), troponin T, lactate, and clinical outcomes were measured as trial outcomes.
 
The frequency of patients with antiarrhythmic drug usage was significantly lower in trial groups A and B than in the control group (P = 0.001). The cardiac rhythm resumption time was significantly longer in the control group (344.37 ± 260.45) than in Group A (193.43 ± 297.73) and Group B (170.12 ± 103.58) (P = 0.02). Adenosine injection before aortic declamping (Group B) had the lowest time of cardiac rhythm resumption between the trial groups.
 
Our findings showed that adenosine injection enhanced the efficacy of cardioplegic arrest and myocardial protection during CABG. (Iranian Heart Journal 2023; 24(4): 26-33)