Propofol Is Cardioprotective in a Clinically Relevant Model of Normothermic Blood Cardioplegic Arrest and Cardiopulmonary Bypass

The general anesthetic propofol has been shown to be cardioprotective. However, its benefits when used in cardioplegia during cardiac surgery have not been demonstrated. In this study, we investigated the effects of propofol on metabolic stress, cardiac function, and injury in a clinically relevant model of normothermic cardioplegic arrest and cardiopulmonary bypass. Twenty anesthetized pigs, randomized to propofol treatment ( n = 8) and control ( n =12) groups, were surgically prepared for cardiopulmonary bypass (CPB) and cardioplegic arrest. Doses of warm blood cardioplegia were delivered at 15-min intervals during a 60-min aortic cross-clamped period. Propofol was continuously infused for the duration of CPB and was therefore present in blood cardioplegia. Myocardial biopsies were collected before, at the end of cardioplegic arrest, and 20 mins after the release of the aortic cross-clamp. Hemodynamic parameters were monitored and blood samples collected for cardiac troponin I measurements. Propofol infusion during CPB and before ischemia did not alter cardiac function or myocardial metabolism. Propofol treatment attenuated the changes in myocardial tissue levels of adenine nucleotides, lactate, and amino acids during ischemia and reduced cardiac troponin I release on reperfusion. Propofol treatment reduced measurable hemodynamic dysfunction after cardioplegic arrest when compared to untreated controls. In conclusion, propofol protects the heart from ischemia-reperfusion injury in a clinically relevant experimental model. Propofol may therefore be a useful adjunct to cardioplegic solutions as well as being an appropriate anesthetic for cardiac surgery.

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Pre-cardiopulmonary bypass administration of dexmedetomidine decreases cardiac troponin I level following cardiac surgery with sevoflurane postconditioning

Journal of International Medical Research ◽

10.1177/0300060519856750 ◽

2019 ◽

Vol 47 (8) ◽

pp. 3623-3635

Author(s):

Hong-mei Zhou ◽

Xiao-yan Ling ◽

Yun-jian Ni ◽

Cheng Wu ◽

Zhi-peng Zhu

Keyword(s):

New York ◽

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Cardiac Troponin ◽

Troponin I ◽

Myocardial Damage ◽

Heart Association ◽

Cardiac Troponin I ◽

Sevoflurane Postconditioning ◽

Ctni Level

Objective This study was performed to determine the effect of dexmedetomidine (DEX) administration on myocardial damage in cardiac surgery with sevoflurane postconditioning. Methods We retrospectively examined all cardiac valve replacement surgeries from 1 April 2016 to 30 April 2017. Eligible patients were divided into two groups based on whether DEX was infused. DEX infusion was permitted only between intubation and the beginning of cardiopulmonary bypass (CPB). Sevoflurane was inhaled via the standard postconditioning procedure starting at aortic declamping. The cardiac troponin I (cTnI) level was measured at different time points. The postoperative outcomes and complications were also analyzed. Results One hundred patients were included in the study (DEX group, n = 53; non-DEX group, n = 47). Increased cTnI levels were significantly correlated with the New York Heart Association classification, CPB time, and DEX use. DEX use and the CPB time were potential independent factors contributing to changes in the cTnI level. The cTnI level at 6, 12, and 24 hours postoperatively was remarkably lower in the DEX than non-DEX group by 1.14, 7.83, and 5.86 ng/mL, respectively. Conclusions DEX decreased the cTnI level after CPB when sevoflurane postconditioning was used, especially at 6, 12, and 24 hours postoperatively.

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Comparison of the Effects of Ketamine-Dexmedetomidine and Sevoflurane-Sufentanil Anesthesia on Cardiac Biomarkers After Cardiac Surgery: An Observational Study

Physiological Research ◽

10.33549/physiolres.932224 ◽

2012 ◽

pp. 63-72 ◽

Cited By ~ 13

Author(s):

H. ŘÍHA ◽

T. KOTULÁK ◽

A. BŘEZINA ◽

L. HESS ◽

P. KRAMÁŘ ◽

...

Keyword(s):

Cardiac Surgery ◽

Observational Study ◽

Cardiac Troponin ◽

Troponin I ◽

Ischemia Reperfusion ◽

Artery Bypass ◽

Experimental Studies ◽

Cardiac Troponin I ◽

Cardiac Biomarkers ◽

Cardioprotective Effects

Inhalational anesthetics have demonstrated cardioprotective effects against myocardial ischemia-reperfusion injury. Clinical studies in cardiac surgery have supported these findings, although not with the consistency demonstrated in experimental studies. Recent investigations have questioned the advantages of inhalational over intravenous anesthetics with respect to cardiac protection. Ketamine has been shown to be comparable with sufentanil, and has even demonstrated anti-inflammatory properties. Dexmedetomidine has been established as a sedative/anesthetic drug with analgesic properties, and has also demonstrated myocardial protective effects. In this retrospective observational study, the influence of ketamine-dexmedetomidine-based anesthesia (KET-DEX group; n=17) on the release of cardiac biomarkers was compared with that of sevoflurane-sufentanil-based anesthesia (SEVO group; n=21) in patients undergoing elective coronary artery bypass grafting. Compared with the SEVO group, the KET-DEX group exhibited significantly reduced cardiac troponin I (2.22±1.73 vs. 3.63±2.37 µg/l; P=0.02) and myocardial fraction of creatine kinase (CK-MB) levels (12.4±10.4 vs. 20.3±11.2 µg/l; P=0.01) on the morning of the first postoperative day. Furthermore, cardiac troponin I release, evaluated as the area under the curve, was significantly reduced in the KET-DEX group (32.1±20.1 vs. 50.6±23.2; P=0.01). These results demonstrate the cardioprotective effects of ketamine-dexmedetomidine anesthesia compared with those of sevoflurane-sufentanil anesthesia.

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Abstract 15554: Heart Failure-Related Hyperphosphorylation of Ser199 on Cardiac Troponin I Causes Divergent Effects on Cardiac Function at Baseline and During Ischemia-Reperfusion

Circulation ◽

10.1161/circ.132.suppl_3.15554 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Yuejin Li ◽

Guangshuo Zhu ◽

Cyrus Takahashi ◽

Djahida Bedja ◽

Genaro Ramirez-Correa ◽

...

Keyword(s):

Heart Failure ◽

Relaxation Time ◽

Cardiac Function ◽

Diastolic Function ◽

Cardiac Troponin ◽

Troponin I ◽

Ischemia Reperfusion ◽

Left Ventricular ◽

Cardiac Troponin I

Background: Phosphorylation of cardiac troponin I (cTnI) on Ser199 is significantly increased in human heart failure (HF), however its cardiac impact in vivo remains unknown. In addition, selective proteolysis of cTnI is a marker of myocardial injury and contributes to cardiac dysfunction in ischemia/reperfusion (I/R), and Ser199 phosphorylation affects cTnI proteolysis in vitro, thus whether Ser199 phosphorylation affects cardiac performance during I/R is of great interest. Methods and Results: We generated transgenic mice (TgS200D) carrying cTnI S200D mutation to mimic the site-specific hyperphosphorylation of murine Ser200 (equivalent to human Ser199). Cardiac function was first assessed in vivo using echocardiography. TgS200D mice demonstrated unaltered ejection fraction (EF), significantly prolonged isovolumic relaxation time, and normal left ventricular (LV) chamber size and wall thickness (n=10). LV pressure-volume studies showed preserved dp/dtmax, significantly decreased -dp/dtmin and increased relaxation time constant in TgS200D when compared to non-transgenic (NTg) control group at baseline (n=10). With increasing heart rates, the two groups showed similar enhancement in both systolic and diastolic function, suggesting the positive force-frequency relation is preserved in TgS200D (n=5). After isoproterenol injection (i.v. 40ng/min/kg), although a comparable increase in dp/dtmax was observed in both groups, there was no enhancement of -dp/dtmin in TgS200D in contrast to 15% of increase in NTg (n=5, p=0.019). After ischemia (30 min)/reperfusion (60 min), LV developed pressure was recovered by ~90% in isolated TgS200D hearts but only ~40% in NTg (n=5, p=0.003). Immunoblotting detected cTnI cleavage only in NTg hearts. Conclusions: Our results indicate that hyperphosphorylation of cTnI Ser199 1) impairs basal diastolic function but preserves systolic function, without LV hypertrophy or dilation; 2) blunts cardiac lusitropic response to β-adrenergic stimulation with isoproterenol; 3) protects heart against I/R injury, likely via preventing cTnI degradation. We propose a dual role of cTnI Ser199 hyperphosphorylaiton: contributing to HF with preserved EF but protecting heart during I/R.

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Faculty Opinions recommendation of Simultaneous measurement of cardiac troponin I, B-type natriuretic peptide, and C-reactive protein for the prediction of long-term cardiac outcome after cardiac surgery.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1163593.625346 ◽

2009 ◽

Author(s):

Girish Joshi ◽

Peter Hession

Keyword(s):

Cardiac Surgery ◽

Natriuretic Peptide ◽

Simultaneous Measurement ◽

Cardiac Troponin ◽

Troponin I ◽

Cardiac Troponin I ◽

C Reactive Protein ◽

Reactive Protein ◽

Cardiac Outcome

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Volatile anaesthetics added to cardiopulmonary bypass are associated with reduced cardiac troponin

Perfusion ◽

10.1177/0267659117701562 ◽

2017 ◽

Vol 32 (7) ◽

pp. 547-553 ◽

Cited By ~ 12

Author(s):

Elena Bignami ◽

Marcello Guarnieri ◽

Marina Pieri ◽

Francesco De Simone ◽

Alcira Rodriguez ◽

...

Keyword(s):

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Cardiac Troponin ◽

Troponin I ◽

Myocardial Necrosis ◽

Perioperative Period ◽

Cardiac Surgical Procedures ◽

Control Group ◽

Volatile Anaesthetics ◽

Volatile Agents

Background: Every year, over 1 million cardiac surgical procedures are performed all over the world. Reducing myocardial necrosis could have strong implications in postoperative clinical outcomes. Volatile anaesthetics have cardiac protective properties in the perioperative period of cardiac surgery. However, little data exists on the administration of volatile agents during cardiopulmonary bypass. The aim of this study was to assess if volatile anaesthetics administration during cardiopulmonary bypass reduces cardiac troponin release after cardiac surgery. Materials and methods: We retrospectively analysed data from 942 patients who underwent cardiac surgery in a teaching hospital. The only difference between the groups was the management of anaesthesia during CPB. The volatile group received sevoflurane or desflurane while the control group received a combination of propofol infusion and fentanyl boluses. Patients who received volatile anaesthetics during cardiopulmonary bypass (n=314) were propensity-matched 1:2 with patients who did not receive volatile anaesthetics during CPB (n=628). Results: We found a reduction in peak postoperative troponin I, from 7.8 ng/ml (4.8-13.1) in the non-volatile group to 6.8 ng/ml (3.7-11.8) in the volatile group (p=0.013), with no differences in mortality [2 (0.6%) in the volatile group and 2 (0.3%) in the non-volatile group (p=0.6)]. Conclusions: Adding volatile anaesthetics during cardiopulmonary bypass was associated with reduced peak postoperative troponin levels. Larger studies are required to confirm our data and to assess the effect of volatile agents on survival.

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Heart Failure–Related Hyperphosphorylation in the Cardiac Troponin I C Terminus Has Divergent Effects on Cardiac Function In Vivo

Circulation Heart Failure ◽

10.1161/circheartfailure.117.003850 ◽

2017 ◽

Vol 10 (9) ◽

Cited By ~ 3

Author(s):

Yuejin Li ◽

Guangshuo Zhu ◽

Nazareno Paolocci ◽

Pingbo Zhang ◽

Cyrus Takahashi ◽

...

Keyword(s):

Heart Failure ◽

Cardiac Function ◽

Cardiac Troponin ◽

Troponin I ◽

Cardiac Troponin I ◽

C Terminus

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Isoflurane may not influence postoperative cardiac troponin I release and clinical outcome in adult cardiac surgery

European Journal of Anaesthesiology ◽

10.1097/00003643-200409000-00004 ◽

2004 ◽

Vol 21 (9) ◽

pp. 688-693 ◽

Cited By ~ 23

Author(s):

J.-L. Fellahi ◽

X. Gue ◽

E. Philippe ◽

B. Riou ◽

J.-L. Gerard

Keyword(s):

Cardiac Surgery ◽

Clinical Outcome ◽

Cardiac Troponin ◽

Troponin I ◽

Cardiac Troponin I ◽

Adult Cardiac Surgery

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Cardiac surgery in acute myocardial infarction: crystalloid versus blood cardioplegia – an experimental study

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-020-1058-9 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Andreas Boening ◽

Maximilian Hinke ◽

Martina Heep ◽

Kerstin Boengler ◽

Bernd Niemann ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Cardiac Surgery ◽

Cardiac Function ◽

Infarct Size ◽

Left Ventricular ◽

Coronary Artery Ligation ◽

Cardioplegic Arrest ◽

Blood Cardioplegia ◽

Cardioplegia Solution

Abstract Background Because hearts in acute myocardial infarction are often prone to ischemia-reperfusion damage during cardiac surgery, we investigated the influence of intracellular crystalloid cardioplegia solution (CCP) and extracellular blood cardioplegia solution (BCP) on cardiac function, metabolism, and infarct size in a rat heart model of myocardial infarction. Methods Following euthanasia, the hearts of 50 rats were quickly excised, cannulated, and inserted into a blood-perfused isolated heart apparatus. A regional myocardial infarction was created in the infarction group (18 hearts) for 120 min; the control group (32 hearts) was not subjected to infarction. In each group, either Buckberg BCP or Bretschneider CCP was administered for an aortic clamping time of 90 min. Functional parameters were recorded during reperfusion: coronary blood flow, left ventricular developed pressure (LVDP) and contractility (dp/dt max). Infarct size was determined by planimetry. The results were compared between the groups using analysis of variance or parametric tests, as appropriate. Results Cardiac function after acute myocardial infarction, 90 min of cardioplegic arrest, and 90 min of reperfusion was better preserved with Buckberg BCP than with Bretschneider CCP relative to baseline (BL) values (LVDP 54 ± 11% vs. 9 ± 2.9% [p = 0.0062]; dp/dt max. 73 ± 11% vs. 23 ± 2.7% [p = 0.0001]), whereas coronary flow was similarly impaired (BCP 55 ± 15%, CCP 63 ± 17% [p = 0.99]). The infarct in BCP-treated hearts was smaller (25% of myocardium) and limited to the area of coronary artery ligation, whereas in CCP hearts the infarct was larger (48% of myocardium; p = 0.029) and myocardial necrosis was distributed unevenly to the left ventricular wall. Conclusions In a rat model of acute myocardial infarction followed by cardioplegic arrest, application of BCP leads to better myocardial recovery than CCP.

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