Cyclosporine Protects the Heart during Aortic Valve Surgery
Cyclosporine Protects the Heart during Aortic Valve Surgery
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DOI：
10.1097/aln.0000000000000331
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发表时间：
2014-08-01
期刊：
影响因子：
8.8
通讯作者：
Ovize, Michel
中科院分区：
文献类型：
--
作者：
Chiari, Pascal;Angoulvant, Denis;Ovize, Michel
背景：心脏手术中发生的部分心肌损伤是再灌注损伤的结果。环孢素是一种有效的线粒体通透性转换孔开放抑制剂，可减轻急性ST段抬高型心肌梗死患者的再灌注损伤。本研究探讨是否环孢素的管理，就在主动脉交叉开放将减少心肌损伤的患者接受主动脉瓣surgery.Methods：本研究是一个单中心，前瞻性，随机，单盲，对照试验。61例择期行主动脉瓣手术的患者在主动脉开放前10 min随机分配（计算机生成的随机序列）接受静脉推注环孢素（2.5 mg/kg，环孢素组，n = 30）或生理盐水（对照组，n = 31）。主要终点是心肌肌钙蛋白I的72小时曲线下面积。结果：两组在基线特征和主动脉阻断持续时间方面相似。与对照组相比，环孢霉素组的心肌肌钙蛋白I曲线下面积显著降低35%（242 +/- 225 vs. 155 +/- 71任意单位，平均值+/- SD;平均差异，-86.2 +/- 42.5; 95% CI，-172.3至-0.1; P = 0.03）。在调整各组的主动脉阻断时间后，环孢霉素的有益作用仍然显著（平均差异，-88 +/- 34，95%CI，-157至-19; P = 0.01）。没有治疗的患者有显着的副作用（比值比，0.64; 95%CI，0.16至2.55; P = 0.52）。结论：环孢素管理在再灌注时保护对再灌注损伤的患者接受主动脉瓣手术。这种保护的临床益处需要在更大规模的临床试验中确认。
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.