Original Article A Randomized Controlled Trial of Intra-Aortic Adenosine Infusion Before Release of the Aortic Cross-Clamp During Coronary Artery Bypass Surgery Amany Ammar, PhD, Khaled Mahmoud, PhD 1 , Ahmed Elkersh, PhD, Zeinab Kasemy, PhD Faculty of Medicine, Minoufiya University, Minoufiya, Egypt Objectives: To assess the feasibility, safety, and potential useful effect of adenosine as a postconditioning agent in patients undergoing coronary artery bypass grafting surgeries. Design: Prospective randomized controlled study. Setting: University hospital. Participants: The study comprised 60 patients scheduled for coronary artery bypass grafting surgery. Interventions: Adenosine (postconditioning group) or placebo (control group). Adenosine infusion (150 mg/kg/min) for 10 minutes via a cardioplegia needle into the aortic root was started 10 minutes before aortic cross-clamp removal. Measurements and Main Results: Compared with the control group, ejection fraction, fractional shortening, cardiac index (2.9 7 0.3 v 2.2 7 0.3 L/min/m 2 ,p ¼ 0.032 at 60 min postbypass) and diastolic function indices were significantly better in the postconditioning group at most time points in the postbypass period. Cardiac troponin I and creatine kinase-MB release and the inotropic score were significantly lower in the postconditioning group at most time points in the postoperative period. The need for intra-aortic balloon and epicardial pacing were comparable in both groups, whereas incidence of arrhythmia, duration of postoperative mechanical ventilation, and intensive care unit and total hospital stays were significantly lower in the postconditioning group. Conclusions: Adenosine postconditioning provided cardiac protection as evidenced by a favorable outcome on systolic and diastolic function indices, less cardiac troponin I and creatine kinase-MB release, lower incidence of arrhythmia, lower inotropic score, and shorter duration of postoperative mechanical ventilation and intensive care unit stay. & 2017 Elsevier Inc. All rights reserved. Key Words: adenosine; coronary artery bypass grafting; postconditioning; ischemia/reperfusion injury ISCHEMIA/REPERFUSION (I/R) injuries are principally responsible for major morbidities and mortality after cardiac surgery. 1 The ischemic postconditioning concept refers to the phenomenon of organ protection against I/R injury by provid- ing multiple, brief periods of reperfusion interspersed with brief periods of ischemia. The same effect can be produced by drugs that stimulate the same cascade and biochemistry of ischemic postconditioning. 2,3 Many experimental and clinical studies have shown that adenosine administration before ischemia or at the onset of reperfusion is able to reduce I/R injury. 4–9 The mechanisms for adenosine’s cardioprotection, which have been revealed by many experimental studies, include activation of the protein kinase C (PKC)–mediated pathway, which explains cardiac protection provided by ischemic preconditioning. 4–8 Many clinical trials in humans have demonstrated cardioprotection Contents lists available at ScienceDirect journal homepage: www.jcvaonline.com http://dx.doi.org/10.1053/j.jvca.2017.10.041 1053-0770/& 2017 Elsevier Inc. All rights reserved. 1 Address reprint requests to Khaled Mahmoud, PhD, 2 Yaseen Abdel- Ghaffar St., Shebin Elkoam, Minoufiya 32511, Egypt. E-mail address: mahmoudk16@yahoo.com (K. Mahmoud). Please cite this article as: Ammar A, et al. (2017), http://dx.doi.org/10.1053/j.jvca.2017.10.041 Journal of Cardiothoracic and Vascular Anesthesia ] (]]]]) ]]]–]]]