Propofol cardioplegia: A single-center, placebo-controlled, randomized controlled trial

Chris A Rogers, Alan J Bryan, Rachel Nash, M Saadeh Suleiman, Sarah Baos, Zoe Plummer, James Hillier, Ian Davies, Richard Downes, Eamonn Nicholson, Barnaby C Reeves, Gianni D Angelini

Research output: Contribution to journalArticle (Academic Journal)peer-review

12 Citations (Scopus)
278 Downloads (Pure)

Abstract

OBJECTIVES: Cardiac surgery with cardiopulmonary bypass and cardioplegic arrest is an effective treatment for coronary artery and aortic valve diseases. However, the myocardium sustains reperfusion injury after ischemic cardioplegic arrest. Our objective was to assess the benefits of supplementing cardioplegia solution with the general anesthetic propofol in patients undergoing either coronary artery bypass grafting (CABG) or aortic valve replacement (AVR).

METHODS: A single-center, double-blind randomized controlled trial was carried out to compare cardioplegia solution supplemented with propofol (concentration 6 μg/mL) versus intralipid (placebo). The primary outcome was cardiac troponin T release over the first 48 hours after surgery.

RESULTS: We recruited 101 participants (51 in the propofol group, 50 in the intralipid group); 61 underwent CABG and 40 underwent AVR. All participants were followed to 3 months. Cardiac troponin T release was on average 15% lower with propofol supplementation (geometric mean ratio, 0.85; 95% confidence interval [CI], 0.73-1.01; P = .051). There were no differences for CABG participants but propofol-supplemented participants undergoing AVR had poorer postoperative renal function (geometric mean ratio, 1.071; 95% CI, 1.019-1.125; P = .007), with a trend toward longer intensive care stay (median, 89.5 vs 47.0 hours; hazard ratio, 0.58; 95% CI, 0.31-1.09; P = .09) and fewer with perfect health (based on the EQ-5D health utility index) at 3 months (odds ratio, 0.26; 95% CI, 0.06-1.05; P = .058) compared with the intralipid group. Safety profiles were similar. There were no deaths.

CONCLUSIONS: Propofol supplementation in cardioplegia appears to be cardioprotective. Its influence on early clinical outcomes may differ between CABG and AVR surgery. A larger, multicenter study is needed to confirm or refute these suggestions.

Original languageEnglish
Article number13
Pages (from-to)1610-1619
Number of pages24
JournalJournal of Thoracic and Cardiovascular Surgery
Volume150
Issue number6
Early online date30 Jun 2015
DOIs
Publication statusPublished - 1 Dec 2015

Structured keywords

  • BTC (Bristol Trials Centre)
  • Centre for Surgical Research

Keywords

  • cardioplegia
  • cardiopulmonary bypass
  • CABG
  • AVR
  • propofol

Fingerprint

Dive into the research topics of 'Propofol cardioplegia: A single-center, placebo-controlled, randomized controlled trial'. Together they form a unique fingerprint.

Cite this