• Pascal Chiari, Olivier Desebbe, Michel Durand, Marc-Olivier Fischer, Diane Lena-Quintard, Jean-Charles Palao, Géraldine Samson, Yvonne Varillon, Bernadette Vaz, Pierre Joseph, Arnaud Ferraris, Matthias Jacquet-Lagreze, Matteo Pozzi, Delphine Maucort-Boulch, Michel Ovize, Gabriel Bidaux, Nathan Mewton, Jean-Luc Fellahi, and ProCCard Trial Investigators.
• Service d'Anesthésie-Réanimation, Hôpital Louis Pradel, Hospices Civils de Lyon, Lyon, France; Inserm U1060, Laboratoire CarMeN, IHU OPeRa, Lyon, France.. Electronic address: pascal.chiari@chu-lyon.fr.
• J. Cardiothorac. Vasc. Anesth. 2023 Aug 1; 37 (8): 136813761368-1376.

ObjectiveThe ProCCard study tested whether combining several cardioprotective interventions would reduce the myocardial and other biological and clinical damage in patients undergoing cardiac surgery.DesignProspective, randomized, controlled trial.SettingMulticenter tertiary care hospitals.Participants210 patients scheduled to undergo aortic valve surgery.InterventionsA control group (standard of care) was compared to a treated group combining five perioperative cardioprotective techniques: anesthesia with sevoflurane, remote ischemic preconditioning, close intraoperative blood glucose control, moderate respiratory acidosis (pH 7.30) just before aortic unclamping (concept of the "pH paradox"), and gentle reperfusion just after aortic unclamping.Measurements And Main ResultsThe primary outcome was the postoperative 72-h area under the curve (AUC) for high-sensitivity cardiac troponin I (hsTnI). Secondary endpoints were biological markers and clinical events occurring during the 30 postoperative days and the prespecified subgroup analyses. The linear relationship between the 72-h AUC for hsTnI and aortic clamping time, significant in both groups (p < 0.0001), was not modified by the treatment (p = 0.57). The rate of adverse events at 30 days was identical. A non-significant reduction of the 72-h AUC for hsTnI (-24%, p = 0.15) was observed when sevoflurane was administered during cardiopulmonary bypass (46% of patients in the treated group). The incidence of postoperative renal failure was not reduced (p = 0.104).ConclusionThis multimodal cardioprotection has not demonstrated any biological or clinical benefit during cardiac surgery. The cardio- and reno-protective effects of sevoflurane and remote ischemic preconditioning therefore remain to be demonstrated in this context.Copyright © 2023 Elsevier Inc. All rights reserved.

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