title: Cyclosporine protects the heart during aortic valve surgery.
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.
authors: From the Department of Anesthesiology and Critical Care (P.C., O.D., O.B., J.-J.L.), Clinical Investigation Center (N.M., M.O.), Department of Cardiology (N.M., M.O.), and Department of Cardiothoracic Surgery (J.-F.O., J.R., F.F., O.J.), Centre Hospitalier Universitaire Louis Pradel, Lyon, France; Lyon University, Inserm U1060, CarMeN Laboratory, Univ Lyon-1, Lyon, France (P.C., N.M., J.-F.O., O.J., M.O.); and Department of Cardiology, Centre Hospitalier Universitaire de Tours and EA 4245 François Rabelais University, Tours, France (D.A.).
authors: Pascal
authors: P
authors: Chiari
authors: Denis
authors: D
authors: Angoulvant
authors: Nathan
authors: N
authors: Mewton
authors: Olivier
authors: O
authors: Desebbe
authors: Jean-François
authors: JF
authors: Obadia
authors: Jacques
authors: J
authors: Robin
authors: Fadi
authors: F
authors: Farhat
authors: Olivier
authors: O
authors: Jegaden
authors: Olivier
authors: O
authors: Bastien
authors: Jean-Jacques
authors: JJ
authors: Lehot
authors: Michel
authors: M
authors: Ovize
mesh_terms: D000368:Aged; D000758:Anesthesia; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D016572:Cyclosporine / Q000627:therapeutic use*; D004452:Echocardiography; D023381:Endpoint Determination; D005260:Female; D006331:Heart Diseases / Q000000981:diagnostic imaging / Q000517:prevention & control*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007431:Intraoperative Complications / Q000000981:diagnostic imaging / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D015428:Myocardial Reperfusion Injury / Q000000981:diagnostic imaging / Q000517:prevention & control*; D059035:Perioperative Period; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000517:prevention & control*; D011446:Prospective Studies; D018401:Sample Size; D016037:Single-Blind Method; D016896:Treatment Outcome; D019210:Troponin I / Q000378:metabolism
chemical_list: D007166:Immunosuppressive Agents; D019210:Troponin I; D016572:Cyclosporine