Cardioplegia, CPD Cardioplegia, Blood Cardioplegia, Microplegia, Micro Cardioplegia, Myocardial Protection, Myocardial Protection Cardioplegia - Adenocaine and the Thermacor 1200 from Smisson-Cartledge Biomedical

Excellent Outcomes in a Case of Complex Re-do Surgery requiring Prolonged Cardioplegia using a New Cardioprotective Approach: Adenocaine

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Authors:  O'Rullian JJ, Clayson SE, Peragallo R

Department of Perfusion, Department of Surgery, and Department of Anesthesiology, Intermountain Medical Center (Intermountain Health Care), Murray, Utah

Abstract:  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 (-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 opera-tion. 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 anti-arrhythmic 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.

 

Keywords: myocardial protection, microplegia, adenosine, lidocaine, polarized arrest, cardioplegia.