Excellent outcomes in a case of complex re-do surgery requiring prolonged cardioplegia using a new cardioprotective approach: adenocaine.
A 71-year-old high-risk fourth-time redo male patient was diagnosed with prosthetic valve endocarditis of both aortic and mitral valves, and subsequently required a re-operative aortic and mitral valve replacement. He was placed on cardiopulmonary bypass (CPB) and arrested with normothermic hyperkalemic all-blood cardioplegia (microplegia) containing adjunctive adenosine-lidocaine-magnesium (adenocaine); aerobic arrest was maintained with near-continuous retrograde low potassium (approximately 2 mEq/L) adenocaine microplegia. After 4 hours of arrest on CPB, the aortic valve was found to be incompetent and was resected. A root replacement was required utilizing a Medtronic Freestyle Root prosthesis. Four separate periods of cross-clamp were required during the course of the entire operation. The patient was on CPB for 9.8 hours with a total cross-clamp time of 7 hours, during which he received 72 liters of all-blood adenocaine microplegia. After a terminal "hot shot" with adenocaine microplegia and no added potassium, CPB was discontinued with no systemic hyperkalemia (5.1 mmol/L), no hemodilution (hematocrit, 24%), no balloon pump, no antiarrhythmic agents, and modest inotropic support. The patient was hemodynamically stable, was extubated in 12 hours, and was transferred out of the cardiac ICU after 48 hours with a subsequent uneventful recovery.
The Department of Cardiac Perfusion, Intermountain Medical Center, 5121 South Cottonwood Street, Murray, UT 84157, USA. jorullian@comcast.net
James J
JJ
O'Rullian
Stephen E
SE
Clayson
Raul
R
Peragallo
D000241:Adenosine / Q000008:administration & dosage; D000368:Aged; D002315:Cardiopulmonary Bypass / Q000379:methods*; D002316:Cardiotonic Agents / Q000008:administration & dosage*; D013504:Cardiovascular Surgical Procedures / Q000009:adverse effects* / Q000379:methods*; D004359:Drug Therapy, Combination; D006801:Humans; D006947:Hyperkalemia / Q000209:etiology / Q000517:prevention & control*; D008012:Lidocaine / Q000008:administration & dosage; D008274:Magnesium / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D012086:Reoperation / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome
D002316:Cardiotonic Agents; D008012:Lidocaine; D008274:Magnesium; D000241:Adenosine