Sevoflurane but Not Propofol Preserves Myocardial Function During Minimally Invasive Direct Coronary Artery Bypass Surgery

Abstract

Volatile anesthetics exert cardioprotective properties in experimental and clinical studies. We designed this study to investigate the effects of sevoflurane on left ventricular (LV) performance during minimally invasive direct coronary artery bypass grafting (MIDCAB) without cardiopulmonary bypass. Fifty-two patients scheduled for MIDCAB surgery were randomly assigned to a propofol or a sevoflurane group. Apart from the anesthetics used, there was no difference in surgical and anesthetic management. After determination of cardiac troponin T, creatine kinase, and creatine kinase MB, electrocardiographic (ECG) data and echocardiography variables (myocardial performance index and early to atrial filling velocity ratio) the left anterior descending coronary artery (LAD) was clamped until anastomosis with the left internal mammary artery was completed. During LAD occlusion and during reperfusion, echocardiography measurements were repeated. Blood samples were obtained repeatedly for up to 72 h. After LAD occlusion, myocardial performance index and early to atrial filling velocity ratio in the propofol group deteriorated significantly from 0.40 +/- 0.12 and 1.29 +/- 0.35 to 0.49 +/- 0.10 and 1.13 +/- 0.22, respectively, whereas there was no change in the sevoflurane group. In the propofol group myocardial performance index remained increased (0.47 +/- 0.11) compared with baseline during reperfusion. There were no significant differences in ECG and laboratory values between groups. In conclusion, during a brief period of ischemia in patients undergoing MIDCAB surgery, sevoflurane preserved myocardial function better than propofol.

Comparison of haemodynamics and myocardial injury markers under desflurane vs. propofol anaesthesia for off-pump coronary surgery. A prospective randomised trial

“…In two studies published recently, late postconditioning with sevoflurane used for sedation after coronary surgery also did not provide reduction of troponin release [19,20]. In our patients, the time of ischaemia (median 11 min) was shorter than reported in studies demonstrating significant cardioprotective effect of volatile anaesthesia for off-pump coronary surgery (> 15 min) [11]. Thus, it is very likely that in our study, the time of ischaemia was not long enough to result in myocardial damage and the cardioprotective effect of desflurane could not manifest itself explicitly.…”

“…Propofol, when compared to sevoflurane, in patients undergoing off-pump coronary surgery has been shown to be related to deeper left ventricular function compromise and delayed recovery of haemodynamic parameters [11]. Similarly, lower cardiac output after 15 min reperfusion and higher troponin I concentration was observed in off-pump coronary surgery under propofol anaesthesia when com- Table 3.…”

Sevoflurane vs propofol in high risk cardiac surgery: design of the randomized trial “Sevo-Aifa”

“…Many studies (11)(12)(13)(14)(15)(16)18,19) and reviews (21)(22) have appeared in the literature suggesting a cardioprotective effect provided by volatile anesthetics in patients undergoing cardiac procedures. A recent survey (23) conducted in 64 Italian centres, encompassing a total of 34,310 patients undergoing coronary artery bypass graft surgery, showed that risk-adjusted mortality may be reduced by the use of volatile agents.…”

Ischemic and Pharmacological Preconditioning (part 2)

“…Кардиопротективные эффекты ингаляционных анесте тиков при операциях на коронарных артериях подтверждены и другими исследованиями [18,19].…”