Intentional asystole during endoluminal thoracic aortic surgery without cardiopulmonary bypass

We describe in three patients the use of adenosine to arrest the heart without cardiopulmonary bypass during endoluminal repair of thoracic aortic aneurysms. The pharmacology of adenosine, a purine nucleoside present in all cells, is reviewed briefly, with special reference to its use in causing transient asystole, which is required for successful surgical expansion of the graft stent in the thoracic aorta.