Sandrine Lemoine1, Lan Zhu2, Jean-Louis Gérard2, Jean-Luc Hanouz3. 1. Department of Anaesthesiology and Intensive Care, Université Caen-Normandie, Centre Hospitalier Universitaire de Caen, 14033 Caen, France. Electronic address: sand.lemoine2@wanadoo.fr. 2. Department of Anaesthesiology and Intensive Care, Université Caen-Normandie, Centre Hospitalier Universitaire de Caen, 14033 Caen, France. 3. Department of Anaesthesiology and Intensive Care, Université Caen-Normandie, Centre Hospitalier Universitaire de Caen, 14033 Caen, France; EA 4650, Université Caen-Normandie, Centre Hospitalier Universitaire de Caen, 14033 Caen, France.
Abstract
BACKGROUND: Myocardial ischaemia reperfusion injury following cardiac surgery with cardiopulmonary bypass (CPB) increases postoperative mortality. Setting techniques to protect the heart during this critical period therefore represents a considerable challenge. METHOD: A randomised controlled study in Caen University Hospital Centre, investigated whether the clinical cardio protective effects of administration sevoflurane before cardiopulmonary bypass during coronary artery bypass graft surgery (CABG) could translate into protected atrial trabeculae contractility against hypoxia-reoxygenation in vitro. Patients undergoing elective on-pump CABG surgery were allocated to receive either sevoflurane (n=24) or no halogenated volatile anaesthetic (n=21). MAIN OUTCOME MEASURES: the relationship between sevoflurane exposure before CPB and the incidence of major adverse cardiac events, with primary endpoint: the postoperative troponin I peak level, and secondary endpoints: the inotropic support, and the duration of stay in intensive unit and in-hospital stay were chosen as study endpoints. The right atrial was collected at the beginning of bypass surgery for the in vitro experimentation. Isometrically contracting isolated human right atrial trabeculae obtained from the two groups were exposed to 30-min hypoxia followed by 60-min reoxygenation. RESULTS: The patients receiving sevoflurane prior to aortic clamping significantly exhibited less cardiac Troponin I (1.39 [0.34-2.97] vs. 2.80 [2.54-3.64] ng·mL-1 in Control; P=0.03) and required a reduced inotropic drug support (P<0.001). Isolated trabeculae from patients receiving sevoflurane enhanced the recovery of force after reoxygenation compared to the Control group (79±5% vs. 53±8% of baseline in Control; P<0.001). CONCLUSIONS: Administration of sevoflurane before CPB induced cardioprotection in patients undergoing CABG and preconditioned human myocardium against hypoxia-reoxygenation in vitro.
RCT Entities:
BACKGROUND:Myocardial ischaemia reperfusion injury following cardiac surgery with cardiopulmonary bypass (CPB) increases postoperative mortality. Setting techniques to protect the heart during this critical period therefore represents a considerable challenge. METHOD: A randomised controlled study in Caen University Hospital Centre, investigated whether the clinical cardio protective effects of administration sevoflurane before cardiopulmonary bypass during coronary artery bypass graft surgery (CABG) could translate into protected atrial trabeculae contractility against hypoxia-reoxygenation in vitro. Patients undergoing elective on-pump CABG surgery were allocated to receive either sevoflurane (n=24) or no halogenated volatile anaesthetic (n=21). MAIN OUTCOME MEASURES: the relationship between sevoflurane exposure before CPB and the incidence of major adverse cardiac events, with primary endpoint: the postoperative troponin I peak level, and secondary endpoints: the inotropic support, and the duration of stay in intensive unit and in-hospital stay were chosen as study endpoints. The right atrial was collected at the beginning of bypass surgery for the in vitro experimentation. Isometrically contracting isolated human right atrial trabeculae obtained from the two groups were exposed to 30-min hypoxia followed by 60-min reoxygenation. RESULTS: The patients receiving sevoflurane prior to aortic clamping significantly exhibited less cardiac Troponin I (1.39 [0.34-2.97] vs. 2.80 [2.54-3.64] ng·mL-1 in Control; P=0.03) and required a reduced inotropic drug support (P<0.001). Isolated trabeculae from patients receiving sevoflurane enhanced the recovery of force after reoxygenation compared to the Control group (79±5% vs. 53±8% of baseline in Control; P<0.001). CONCLUSIONS: Administration of sevoflurane before CPB induced cardioprotection in patients undergoing CABG and preconditioned human myocardium against hypoxia-reoxygenation in vitro.
Authors: Hans Erik Bøtker; Derek Hausenloy; Ioanna Andreadou; Salvatore Antonucci; Kerstin Boengler; Sean M Davidson; Soni Deshwal; Yvan Devaux; Fabio Di Lisa; Moises Di Sante; Panagiotis Efentakis; Saveria Femminò; David García-Dorado; Zoltán Giricz; Borja Ibanez; Efstathios Iliodromitis; Nina Kaludercic; Petra Kleinbongard; Markus Neuhäuser; Michel Ovize; Pasquale Pagliaro; Michael Rahbek-Schmidt; Marisol Ruiz-Meana; Klaus-Dieter Schlüter; Rainer Schulz; Andreas Skyschally; Catherine Wilder; Derek M Yellon; Peter Ferdinandy; Gerd Heusch Journal: Basic Res Cardiol Date: 2018-08-17 Impact factor: 17.165