title: Propofol cardioplegia: A single-center, placebo-controlled, randomized controlled trial.
abstract: OBJECTIVE
  Cardiac surgery with cardiopulmonary bypass and cardioplegic arrest is an effective treatment for coronary artery and aortic valve diseases. However, the myocardium sustains reperfusion injury after ischemic cardioplegic arrest. Our objective was to assess the benefits of supplementing cardioplegia solution with the general anesthetic propofol in patients undergoing either coronary artery bypass grafting (CABG) or aortic valve replacement (AVR).
  
  
  METHODS
  A single-center, double-blind randomized controlled trial was carried out to compare cardioplegia solution supplemented with propofol (concentration 6 μg/mL) versus intralipid (placebo). The primary outcome was cardiac troponin T release over the first 48 hours after surgery.
  
  
  RESULTS
  We recruited 101 participants (51 in the propofol group, 50 in the intralipid group); 61 underwent CABG and 40 underwent AVR. All participants were followed to 3 months. Cardiac troponin T release was on average 15% lower with propofol supplementation (geometric mean ratio, 0.85; 95% confidence interval [CI], 0.73-1.01; P = .051). There were no differences for CABG participants but propofol-supplemented participants undergoing AVR had poorer postoperative renal function (geometric mean ratio, 1.071; 95% CI, 1.019-1.125; P = .007), with a trend toward longer intensive care stay (median, 89.5 vs 47.0 hours; hazard ratio, 0.58; 95% CI, 0.31-1.09; P = .09) and fewer with perfect health (based on the EQ-5D health utility index) at 3 months (odds ratio, 0.26; 95% CI, 0.06-1.05; P = .058) compared with the intralipid group. Safety profiles were similar. There were no deaths.
  
  
  CONCLUSIONS
  Propofol supplementation in cardioplegia appears to be cardioprotective. Its influence on early clinical outcomes may differ between CABG and AVR surgery. A larger, multicenter study is needed to confirm or refute these suggestions.
authors.affiliation: Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom. Electronic address: chris.rogers@bristol.ac.uk.
authors.forename: Chris A
authors.initials: CA
authors.lastname: Rogers
authors.affiliation: Bristol Heart Institute, University Hospitals Bristol National Health Service Foundation Trust and University of Bristol, Bristol, United Kingdom.
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Bryan
authors.affiliation: Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom.
authors.forename: Rachel
authors.initials: R
authors.lastname: Nash
authors.affiliation: Bristol Heart Institute, University Hospitals Bristol National Health Service Foundation Trust and University of Bristol, Bristol, United Kingdom.
authors.forename: M Saadeh
authors.initials: MS
authors.lastname: Suleiman
authors.affiliation: Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom.
authors.forename: Sarah
authors.initials: S
authors.lastname: Baos
authors.affiliation: Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom.
authors.forename: Zoe
authors.initials: Z
authors.lastname: Plummer
authors.affiliation: Bristol Heart Institute, University Hospitals Bristol National Health Service Foundation Trust and University of Bristol, Bristol, United Kingdom.
authors.forename: James
authors.initials: J
authors.lastname: Hillier
authors.affiliation: Bristol Heart Institute, University Hospitals Bristol National Health Service Foundation Trust and University of Bristol, Bristol, United Kingdom.
authors.forename: Ian
authors.initials: I
authors.lastname: Davies
authors.affiliation: Bristol Heart Institute, University Hospitals Bristol National Health Service Foundation Trust and University of Bristol, Bristol, United Kingdom.
authors.forename: Richard
authors.initials: R
authors.lastname: Downes
authors.affiliation: Bristol Heart Institute, University Hospitals Bristol National Health Service Foundation Trust and University of Bristol, Bristol, United Kingdom.
authors.forename: Eamonn
authors.initials: E
authors.lastname: Nicholson
authors.affiliation: Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom.
authors.forename: Barnaby C
authors.initials: BC
authors.lastname: Reeves
authors.affiliation: Bristol Heart Institute, University Hospitals Bristol National Health Service Foundation Trust and University of Bristol, Bristol, United Kingdom.
authors.forename: Gianni D
authors.initials: GD
authors.lastname: Angelini
mesh_terms: D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000601:surgery; D000082882:Bicuspid Aortic Valve Disease; D002314:Cardioplegic Solutions / Q000008:administration & dosage*; D001026:Coronary Artery Bypass; D004311:Double-Blind Method; D004655:Emulsions / Q000008:administration & dosage; D005260:Female; D006324:Heart Arrest, Induced / Q000379:methods*; D006330:Heart Defects, Congenital / Q000601:surgery*; D006349:Heart Valve Diseases / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010743:Phospholipids / Q000008:administration & dosage; D015742:Propofol / Q000008:administration & dosage*; D013024:Soybean Oil / Q000008:administration & dosage; D016896:Treatment Outcome; D020107:Troponin T / Q000378:metabolism
chemical_list: D002314:Cardioplegic Solutions; D004655:Emulsions; D010743:Phospholipids; D020107:Troponin T; C545823:soybean oil, phospholipid emulsion; D013024:Soybean Oil; D015742:Propofol
keywords: AVR; CABG; cardioplegia; cardiopulmonary bypass; propofol