Adenosine in myocardial protection in on-pump and off-pump cardiac surgery.
Adenosine is most well known for its potent vasodilation of the vasculature. However, it also promotes glycolysis, and activates potassium-sensitive adenosine triphosphate (K(ATP)) channels. Adenosine also strongly inhibits neutrophil function such as superoxide anion production, protease release, and adherence to coronary endothelial cells. Hence adenosine attenuates ischemic injury as well as neutrophil-mediated reperfusion injury. Adenosine has also been implicated in the cardioprotective phenomenon of ischemic preconditioning. Accordingly experimental evidence shows that adenosine reduces postischemic injury when administered before ischemia and at the onset of reperfusion. Clinical studies in cardiology and cardiac surgery show cardioprotective trends with adenosine treatment but the effects are not as dramatic as those reported by experimental studies.
Vinten-Johansen
Jakob
J
The Cardiothoracic Research Laboratory, Department of Surgery, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia 30308-2225, USA. jvinten@emory.edu
Zhao
Zhi-Qing
ZQ
Corvera
Joel S
JS
Morris
Cullen D
CD
Budde
Jason M
JM
Thourani
Vinod H
VH
Guyton
Robert A
RA
D000241:Adenosine / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D015906:Angioplasty, Balloon, Coronary; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass; D006324:Heart Arrest, Induced; D006801:Humans; D019157:Ischemic Preconditioning, Myocardial; D009203:Myocardial Infarction / Q000503:physiopathology; D015428:Myocardial Reperfusion Injury / Q000517:prevention & control*; D015221:Potassium Channels / Q000502:physiology; D018047:Receptors, Purinergic P1; D015912:Thrombolytic Therapy; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*
D015221:Potassium Channels; D018047:Receptors, Purinergic P1; D014665:Vasodilator Agents; D000241:Adenosine