Esmolol before cardioplegia and as cardioplegia adjuvant reduces cardiac troponin release after cardiac surgery. A randomized trial
| Autor: | Fabrizio Monaco, Monica De Luca, Alberto Zangrillo, Elena Bignami, Marcello Guarnieri, Annalisa Franco, Chiara Gerli, Giovanni Landoni |
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| Přispěvatelé: | Bignami, Elena, Guarnieri, Marcello, Franco, Annalisa, Gerli, Chiara, De Luca, Monica, Monaco, Fabrizio, Landoni, Giovanni, Zangrillo, Alberto |
| Rok vydání: | 2016 |
| Předmět: |
Male
Radiology Nuclear Medicine and Imaging medicine.medical_specialty Cardiac troponin medicine.medical_treatment Ischemia esmolol anesthesia 030204 cardiovascular system & hematology cardiac anesthesia law.invention Propanolamines 03 medical and health sciences 0302 clinical medicine Double-Blind Method Troponin T Randomized controlled trial law Intensive care Internal medicine medicine Humans Radiology Nuclear Medicine and imaging 030212 general & internal medicine Cardiac Surgical Procedures intensive care Advanced and Specialized Nursing biology troponin business.industry General Medicine Middle Aged Esmolol medicine.disease Adrenergic beta-1 Receptor Antagonists Troponin Cardiac surgery Anesthesia Heart Arrest Induced biology.protein Cardiology cardioplegia Female Cardiology and Cardiovascular Medicine business Safety Research Adjuvant medicine.drug |
| Zdroj: | Perfusion. 32:313-320 |
| ISSN: | 1477-111X 0267-6591 |
| Popis: | Background: Cardioplegic solutions are the standard in myocardial protection during cardiac surgery, since they interrupt the electro-mechanical activity of the heart and protect it from ischemia during aortic cross-clamping. Nevertheless, myocardial damage has a strong clinical impact. We tested the hypothesis that the short-acting beta-blocker esmolol, given immediately before cardiopulmonary bypass and as a cardioplegia additive, would provide an extra protection to myocardial tissue during cardiopulmonary bypass by virtually reducing myocardial activity and, therefore, oxygen consumption to zero. Materials and methods: This was a single-centre, double-blind, placebo-controlled, parallel-group phase IV trial. Adult patients undergoing elective valvular and non-valvular cardiac surgery with end diastolic diameter >60 mm and ejection fraction ® crystalloid cardioplegia or equivolume placebo. The primary end-point was peak postoperative troponin T concentration. Troponin was measured at Intensive Care Unit arrival and at 4, 24 and 48 hours. Secondary endpoints included ventricular fibrillation after cardioplegic arrest, need for inotropic support and intensive care unit and hospital stay. Results: We found a reduction in peak postoperative troponin T, from 1195 ng/l (690–2730) in the placebo group to 640 ng/l (544–1174) in the esmolol group (p=0.029) with no differences in Intensive Care Unit stay [3 days (1-6) in the placebo group and 3 days (2-5) in the esmolol group] and hospital stay [7 days (6–10) in the placebo group and 7 days (6–12) in the esmolol group]. Troponin peak occurred at 24 hours for 12 patients (26%) and at 4 hours for the others (74%). There were no differences in other secondary end-points. Conclusions: Adding esmolol to the cardioplegia in high-risk patients undergoing elective cardiac surgery reduces peak postoperative troponin levels. Further investigation is necessary to assess esmolol effects on major clinical outcomes. |
| Databáze: | OpenAIRE |
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