Skip Navigation LinksHome > August 2014 - Volume 121 - Issue 2 > Cyclosporine Protects the Heart during Aortic Valve Surgery
Anesthesiology:
doi: 10.1097/ALN.0000000000000331
Perioperative Medicine: Clinical Science

Cyclosporine Protects the Heart during Aortic Valve Surgery

Chiari, Pascal M.D., Ph.D.; Angoulvant, Denis M.D., Ph.D.; Mewton, Nathan M.D., Ph.D.; Desebbe, Olivier M.D.; Obadia, Jean-François M.D., Ph.D.; Robin, Jacques M.D., Ph.D.; Farhat, Fadi M.D., Ph.D.; Jegaden, Olivier M.D., Ph.D.; Bastien, Olivier M.D., Ph.D.; Lehot, Jean-Jacques M.D., Ph.D.; Ovize, Michel M.D., Ph.D.

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Abstract

Background: Part of the myocardial damage occurring during cardiac surgery is a consequence of reperfusion injury. Cyclosporine, a potent inhibitor of the opening of the mitochondrial permeability transition pore, attenuates reperfusion injury in patients with acute ST-segment elevation myocardial infarction. This study investigated whether the administration of cyclosporine just before the aortic cross-unclamping would reduce myocardial injury in patients undergoing aortic valve surgery.
Methods: This study was a monocentric, prospective, randomized, single-blinded, controlled trial. Sixty-one patients, scheduled for elective aortic valve surgery, were randomly assigned (computer-generated randomization sequence) to receive either an intravenous bolus of cyclosporine (2.5 mg/kg, cyclosporine group, n = 30) or normal saline (control group, n = 31) 10 min before aortic cross-unclamping. The primary endpoint was the 72-h area under the curve for cardiac troponin I.
Results: Both groups were similar with respect to baseline characteristics and aortic cross-clamping duration. A significant 35% reduction of area under the curve for cardiac troponin I was observed in the cyclosporine group compared with the control group (242 ± 225 vs. 155 ± 71 arbitrary units, mean ± SD; mean difference, −86.2 ± 42.5; 95% CI, −172.3 to −0.1; P = 0.03). Cyclosporine beneficial effect remained significant after adjustment for aortic cross-clamping duration in each group (mean difference, −88 ± 34, 95% CI, −157 to −19; P = 0.01). None of the treated patients had significant side effects (odds ratio, 0.64; 95% CI, 0.16 to 2.55; P = 0.52).
Conclusions: Cyclosporine administration at the time of reperfusion protects against reperfusion injury in patients undergoing aortic valve surgery. The clinical benefit of this protection requires confirmation in a larger clinical trial.

© 2014 American Society of Anesthesiologists, Inc.

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