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Transient ventricular asystole using adenosine during minimally invasive and open sternotomy coronary artery bypass
M C Robinson1, K A Thielmeier, B B Hill
1Division of Cardiothoracic Surgery, University of Kentucky and Veterans Affairs Hospital, Lexington 40536, USA. mcrobin@pop.uky.edu
Background:
The emergence of minimally invasive coronary artery bypass grafting and recent off-pump open sternotomy clinical reports have refocused attention on the technical aspects and outcome of grafting on the beating heart.
Methods:
To optimize the surgical field we report a method using adenosine for induction of controlled intervals of ventricular asystole to produce a transiently still cardiac field that facilitates anastomotic accuracy.
Results:
Adenosine was used in 57 patients, 31 included off-pump coronary artery bypass grafting (27 by minimally invasive technique, 4 by open sternotomy). In a further 26 patients adenosine pauses were used for suture placement to control anastomotic bleeding after cardiopulmonary bypass. Average adenosine boluses per anastomosis were 9 (6-14), mean dose of adenosine per bolus (mg/kg) was 0.24 (0.15-0.35), mean duration of pause (seconds) was 6 (3-19), and mean time for arterial blood pressure (mean) to return to baseline (seconds) was 35 (13-48). Presence of repolarization arrhythmias was noted in 1 patient. There were no deaths. Two patients had recurrent myocardial ischemia shown on angiography to be the result of technical problems.
Conclusions:
This report describes our experience with the emerging procedure of minimally invasive coronary operations and off-pump grafting with the adenosine technique. The method also includes mechanical devices and other pharmacological therapy to optimize the surgical field, and the technique has now become a standard component of our off-pump revascularization methods.