Multidiscip Cardio Annal. 2020 January; 11(1):e96919. Published online 2019 December 24. doi: 10.5812/mca.96919. Research Article The Effects of Cold Blood Cardioplegia with and without Adenosine on Hemodynamic Status of Patients Undergoing Mitral Valve Surgery Fahimeh Ghasemi 1 , Rasoul Azarfarin 2 , Sarvenaz Salahi 3 , Bahador Baharestani 3 and Alireza Alizadeh Ghavidel 4, * 1 Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran 2 Cardiac Anesthesiology Department, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran 3 Cardiac Surgery Department, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran 4 Heart Valve Disease Research Center of Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran * Corresponding author: Heart Valve Disease Research Center of Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Postal Code: 1995614331, Tehran, Iran. Tel: +98-9121590518, Email: aaghavidel@gmail.com Received 2019 August 04; Revised 2019 October 14; Accepted 2019 October 14. Abstract Background: Minimizing ischemic-reperfusion injury following valvular heart surgeries is very important with the goal of provid- ing appropriate cardiac systolic function, preventing arrhythmic events as well as inhibiting ischemic related processes. Due to the protective effects of adenosine, this chemical has been used as an additive to a cardioplegic solution for achieving this purpose. Objectives: The present study aimed to assess the effects of cold blood cardioplegia with adenosine on hemodynamic status of patients undergoing mitral valve surgery. Methods: This randomized single-blinded clinical trial was performed on 40 consecutive patients who were candidates for mitral valve surgery. The patients were randomly assigned to receive cold blood cardioplegia in combination with or without adenosine or hyperkalemic cardioplegia as the control. Primary endpoints were returning sinus rhythm, requiring inotropes after cardiopul- monary bypass and secondary endpoints were the change in hemodynamic parameters and postoperative complications. Results: Except for mean time required for induction of cardiac arrest that was significantly shorter in intervention group, no differences were found between the two groups regarding cardiopulmonary bypass time, cross clamp duration, and rhythm return time. In assessment of postoperative consequences, there were no differences in post-procedural events with respect to returning sinus rhythm, requiring inotropes, requiring DC shock, mean intubation time, length of ICU stay and also left ventricular systolic function. Conclusions: Except for reducing the time for inducing cardiac arrest within mitral valve surgery, adding adenosine to cold blood cardioplegia may not be beneficial regarding the improvement of postoperative outcome. Keywords: Cardiopulmonary Bypass, Mitral Valve Surgery, Adenosine, Cardioplegia Solution 1. Background Patients after heart valve surgery are at risk of multi- ple problems, such as atrial fibrillation, bleeding, throm- bosis, respiratory complications and digestive complica- tions, leading to death and potential complications. One of the most important cardiovascular disorders leading to death can be referred to the phenomenon of ischemic- reperfusion event (1). Cardiac ischemia leads to complex complications such as myocardial arrhythmias and conse- quently congestive heart failure. The ischemia-reperfusion phenomenon in myocardium will irreparably lead to is- chemic injury by activating pathological inflammatory processes and apoptosis resulting in tissue death through inducing excessive production of free radicals and oxida- tive stress (2, 3). In fact, due to damage caused by free radi- cal production and active oxygen species during ischemic rejection of perfusion and non-compliance with the an- tioxidant system of the muscular tissue of the heart, my- ocardium will always be exposed to necrosis and apopto- sis. Ischemia-reperfusion injury is known as one of the most important clinical problems. For these reasons, re- searchers have been focusing on protecting and prevent- ing damage from ischemic-reperfusion injury over recent years (4). On the other hand, for cardiac surgery, stopping heart movement is needed to provide a relaxed and blood- Copyright © 2019, Multidisciplinary Cardiovascular Annals. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.