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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 language | English |
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Article number | 13 |
Pages (from-to) | 1610-1619 |
Number of pages | 24 |
Journal | Journal of Thoracic and Cardiovascular Surgery |
Volume | 150 |
Issue number | 6 |
Early online date | 30 Jun 2015 |
DOIs | |
Publication status | Published - 1 Dec 2015 |
Research Groups and Themes
- BTC (Bristol Trials Centre)
- Centre for Surgical Research
Keywords
- cardioplegia
- cardiopulmonary bypass
- CABG
- AVR
- propofol
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Dive into the research topics of 'Propofol cardioplegia: A single-center, placebo-controlled, randomized controlled trial'. Together they form a unique fingerprint.Projects
- 1 Finished
Profiles
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Professor Gianni D Angelini
- Bristol Medical School (THS) - BHF Professor of Cardiac Surgery and Director
- Bristol Population Health Science Institute
Person: Academic , Member
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Professor Chris A Rogers
- Bristol Medical School (PHS) - Professor of Medical Statistics and Clinical Trials
- Bristol Population Health Science Institute
Person: Academic , Member