• Marco Moscarelli, Nora Terrasini, Anna Nunziata, Prakash Punjabi, Gianni Angelini, Marco Solinas, Alba Buselli, SartoPaolo DelPDOperative Unit of Anesthesiology, G. Pasquinucci Heart Hospital, Fondazione Toscana G. Monasterio, Massa, Italy., and Dorela Haxhiademi.
• GVM Care & Research, Anthea Hospital, Bari, Italy. Electronic address: m.moscarelli@imperial.ac.uk.
• J. Cardiothorac. Vasc. Anesth. 2018 Dec 1; 32 (6): 256225692562-2569.

ObjectiveMinimally invasive mitral valve repair may be associated with prolonged cardioplegic arrest times and ischemic reperfusion injury. Intravenous (propofol) and volatile (sevoflurane) anesthesia are used routinely during cardiac surgery and are thought to provide cardioprotection; however, the individual contribution of each regimen to cardioprotection is unknown. Therefore, the authors sought to compare the cardioprotective effects of propofol and sevoflurane anesthesia in patients undergoing minimally invasive mitral valve repair.DesignA single-center single-blind randomized controlled trial.SettingA specialized regional cardiac surgery center in Italy.ParticipantsThe study enrolled 62 adults undergoing elective isolated minimally invasive mitral valve repair for degenerative disease. Exclusion criteria included secondary mitral regurgitation, previously treated coronary artery disease, diabetes mellitus, chronic renal failure requiring dialysis, atrial fibrillation, and documented allergy to either propofol or sevoflurane.InterventionsAll patients received video-assisted minimally invasive right minithoracotomy. Patients were randomized to receive propofol or sevoflurane anesthesia in a 1:1 ratio.Measurements And Main ResultsCardiac troponin I release was measured over the first 72 hours postoperatively. Operative, cross-clamp, and total bypass times were similar between groups. Cardiac troponin I release was reduced nonsignificantly in the propofol group (p = 0.62), and peak troponin I release was correlated with cross-clamp time in both groups. There were no differences in terms of intraoperative lactate release and blood pH between groups.ConclusionPropofol and sevoflurane anesthesia were associated with similar degrees of myocardial injury, indicating comparable cardioprotection. Myocardial injury was related directly to the duration of cardioplegic arrest.Copyright © 2018 Elsevier Inc. All rights reserved.

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