• Alberto Zangrillo, Vladimir V Lomivorotov, Vadim V Pasyuga, Alessandro Belletti, Gordana Gazivoda, Fabrizio Monaco, Nigro NetoCaetanoCAnesthesia Section, Department of Cardiovascular Surgery, Dante Pazzanese Institute of Cardiology, São Paulo, Brazil., Valery V Likhvantsev, Nikola Bradic, Andrey Lozovskiy, Chong Lei, Nazar A R Bukamal, SilvaFernanda SantosFSDepartment of Anaesthesiology, Hospital de Santa Maria, Lisboa, Portugal., Andrey E Bautin, Jun Ma, Chow Yen Yong, Cristiana Carollo, Jan Kunstyr, Chew Yin Wang, Evgeny V Grigoryev, Hynek Riha, Chengbin Wang, Mohamed R El-Tahan, Anna Mara Scandroglio, Marzida Mansor, Rosalba Lembo, Dmitry N Ponomarev, Francisco José Lucena Bezerra, Laura Ruggeri, Alexander M Chernyavskiy, Junmei Xu, Dmitry G Tarasov, Paolo Navalesi, Andrey Yavorovskiy, Tiziana Bove, Artem Kuzovlev, Ludhmila A Hajjar, Giovanni Landoni, and MYRIAD Study Group.
• Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
• J. Cardiothorac. Vasc. Anesth. 2022 Aug 1; 36 (8 Pt A): 2454-2462.

ObjectiveTo investigate the effect of volatile anesthetics on the rates of postoperative myocardial infarction (MI) and cardiac death after coronary artery bypass graft (CABG).DesignA post hoc analysis of a randomized trial.SettingCardiac surgical operating rooms.ParticipantsPatients undergoing elective, isolated CABG.InterventionsPatients were randomized to receive a volatile anesthetic (desflurane, isoflurane, or sevoflurane) or total intravenous anesthesia (TIVA). The primary outcome was hemodynamically relevant MI (MI requiring high-dose inotropic support or prolonged intensive care unit stay) occurring within 48 hours from surgery. The secondary outcome was 1-year death due to cardiac causes.Measurements And Main ResultsA total of 5,400 patients were enrolled between April 2014 and September 2017 (2,709 patients randomized to the volatile anesthetics group and 2,691 to TIVA). The mean age was 62 ± 8.4 years, and the median baseline ejection fraction was 57% (50-67), without differences between the 2 groups. Patients in the volatile group had a lower incidence of MI with hemodynamic complications both in the per-protocol (14 of 2,530 [0.6%] v 27 of 2,501 [1.1%] in the TIVA group; p = 0.038) and as-treated analyses (16 of 2,708 [0.6%] v 29 of 2,617 [1.1%] in the TIVA group; p = 0.039), but not in the intention-to-treat analysis (17 of 2,663 [0.6%] v 28 of 2,667 [1.0%] in the TIVA group; p = 0.10). Overall, deaths due to cardiac causes were lower in the volatile group (23 of 2,685 [0.9%] v 40 of 2,668 [1.5%] than in the TIVA group; p = 0.03).ConclusionsAn anesthetic regimen, including volatile agents, may be associated with a lower rate of postoperative MI with hemodynamic complication in patients undergoing CABG. Furthermore, it may reduce long-term cardiac mortality.Copyright © 2022 Elsevier Inc. All rights reserved.

23 keywords...

hide…