Alternatives for myocardial protection: adenosine-enhanced ischemic preconditioning.
Intrinsic to the development of new myoprotective protocols for use in cardiac surgery are the requirements of new protocols to be equal to or better than conventional cardioplegia in providing for enhanced post-ischemic functional recovery and decreased myocardial infarct size. Our data suggest that adenosine-enhanced ischemic preconditioning, in which a bolus injection of adenosine to the myocardium is used coincident with ischemic preconditioning, meets these requirements, providing equal cardioprotection as that of cold blood cardioplegia, significantly decreasing myocardial infarct size and significantly enhancing post-ischemic myocardial functional recovery in both the isolated perfused rabbit heart and in the in situ blood-perfused sheep heart. These results further suggest that adenosine-enhanced ischemic preconditioning may provide an effective, alternative myocardial protective protocol to reduce the morbidity and mortality in cardiac surgery.
Division of Cardiothoracic Surgery, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
J D
JD
McCully
S
S
Levitsky
D000241:Adenosine / Q000494:pharmacology*; D000818:Animals; D009202:Cardiomyopathies / Q000517:prevention & control*; D006801:Humans; D019157:Ischemic Preconditioning, Myocardial; D011315:Preventive Medicine / Q000379:methods*; D018047:Receptors, Purinergic P1 / Q000502:physiology
D018047:Receptors, Purinergic P1; D000241:Adenosine