Superior Myocardial Protection Using "Polarizing" Adenosine, Lidocaine, and Mg(2+) Cardioplegia in Humans.

[Extract] Myocardial protection with current methods of cardioplegia is still incomplete. Several studies have shown that hyperkalemic solution may lead to cell injury. Adenosine-lidocaine-magnesium (ALM) is a new normokalemic, polarizing method of cardioplegia that arrests the heart at its resting membrane potential. Pre-clinical studies have shown ALM to provide improved protection compared with hyperkalemic solutions. A recent clinical trial also observed improved outcomes with ALM-enriched hyperkalemic cardioplegia. We hypothesized that normokalemic, full-polarizing ALM microplegia from induction to reanimation provides improved myocardial protection compared with hyperkalemic arrest.