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CARDIOVASCULAR ANESTHESIA

Cardioprotective Properties of Sevoflurane in Patients Undergoing Aortic Valve Replacement with Cardiopulmonary Bypass

Stefanie Cromheecke, MD^*, Veronik Pepermans, MD^*, Ellen Hendrickx, MD^*, Sur Lorsomradee, MD^*, Pieter W. ten Broecke, MD^*, Bernard A. Stockman, MD, Inez E. Rodrigus, MD, PhD, and Stefan G. De Hert, MD, PhD^*

From the Departments of *Anesthesiology and Cardiac Surgery, University Hospital Antwerp, Belgium.

Address correspondence and reprint requests to Stefan G. De Hert, MD, PhD, Department of Anesthesiology, University Hospital Antwerp, Wilrijkstraat 10, B-2650 Edegem, Belgium. Address e-mail to stefan.dehert{at}ua.ac.be.

In coronary surgery patients the use of a volatile anesthetic regimen with sevoflurane was associated with a better recovery of myocardial function and less postoperative release of troponin I. In the present study we investigated whether these cardioprotective properties were also apparent in the cardiac surgical setting of aortic valve replacement (AVR) surgery for the correction of aortic stenosis. Thirty AVR surgery patients were randomly assigned to receive either target-controlled infusion of propofol or inhaled anesthesia with sevoflurane. Cardiac function was assessed perioperatively using a pulmonary artery catheter. Perioperatively, a high-fidelity pressure catheter was positioned in the left ventricle. Postoperative concentrations of cardiac troponin I were followed for 48 h. After cardiopulmonary bypass (CPB), stroke volume and dP/dt_max were significantly higher in the patients with sevoflurane. Post-CPB, the effects of an increase in cardiac load on dP/dt_max were similar to pre-CPB in the sevoflurane group (1.0 % ± 5.4% post-CPB versus 1.3% ± 8.6% pre-CPB) but more depressed in the propofol group (–8.2% ± 4.4% post-CPB versus 0.1% ± 4.9% pre-CPB). The rate of relaxation was significantly slower post-CPB in the propofol group. Postoperative levels of troponin I were significantly lower in the sevoflurane group. Our data indicate that the use of a volatile anesthetic regimen in AVR surgery was associated with better preservation of myocardial function and a reduced postoperative release of troponin I.

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