Objective Minimally invasive mitral valve repair may be associated with prolonged cardioplegic arrest times and ischemic reperfusion injury. Intravenous (propofol) and volatile (sevoflurane) anesthesia are routinely used during cardiac surgery and are thought to provide cardioprotection; however, the individual contribution of each regimen to cardioprotection is unknown. Thereby we sought to compare the cardioprotective effects of propofol and sevoflurane anesthesia in patients undergoing minimally invasive mitral valve repair. Design A single-center single blind randomized controlled trial. Setting A specialized regional cardiac surgery center in Italy. Participant The study enrolled 62 adults undergoing elective isolated minimally invasive mitral valve repair for degenerative disease. Exclusion criteria included secondary mitral regurgitation, previously treated coronary artery disease, diabetes mellitus, chronic renal failure requiring dialysis, atrial fibrillation, and documented allergy to either propofol or sevoflurane. Intervention All patients received video-assisted right minimally invasive minithoracotomy. Patients were randomized to receive propofol or sevoflurane anesthesia in a 1:1 ratio. Measurements and main results Cardiac troponin I release was measured over the first 72 h postoperatively. Operative, cross clamp, and total bypass times were similar between groups. Cardiac troponin I release was non-significantly reduced in the propofol group (p = 0.62) and peak troponin I release was correlated with cross clamp time in both groups. There were no differences in terms of intraoperative lactate release and blood pH in between groups. Conclusions Propofol and sevoflurane anesthesia were associated with similar degrees of myocardial injury, indicating comparable cardioprotection. Myocardial injury was directly related to the duration of cardioplegic arrest.
- Centre for Surgical Research
- mitral valve
- reperfusion injury
- troponin I
Moscarelli, M., Terrasini, N., Nunziata, A., Punjabi, P., Angelini, G., Solinas, M., Buselli, A., Sarto, P. D., & Haxhiademi, D. (2018). A Trial of Two Anesthetic Regimes for Minimally Invasive Mitral Valve Repair. Journal of Cardiothoracic and Vascular Anesthesia, 32(6), 2562-2569. https://doi.org/10.1053/j.jvca.2018.01.028