Key result
Cyclosporine administered before aortic cross-unclamping reduced the 72-h area under the curve for cardiac troponin I compared to saline (MD -86.2; 95% CI -172.3 to -0.1; P=0.03).
Why the study?
Does an intravenous bolus of cyclosporine reduce myocardial injury (measured by 72-h area under the curve for cardiac troponin I) in patients undergoing elective aortic valve surgery?
RCT (n=61)
Single-blind
computer-generated randomization sequence
No
Does an intravenous bolus of cyclosporine reduce myocardial injury (measured by 72-h area under the curve for cardiac troponin I) in patients undergoing elective aortic valve surgery?
Administration of intravenous cyclosporine prior to aortic cross-unclamping significantly reduces myocardial reperfusion injury during elective aortic valve surgery.
Answers are grounded in this paper and cite their sources.
Supports cyclosporine before unclamping to limit injury in valve surgery; extends mitochondrial cardioprotection evidence to aortic procedures.
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.
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Chiari et al. (2014) conducted an RCT in elective aortic valve surgery (n=61). Cyclosporine vs. Normal saline was evaluated on 72-h area under the curve for cardiac troponin I (MD -86.2, 95% CI -172.3 to -0.1, p=0.03). Cyclosporine administered before aortic cross-unclamping reduced the 72-h area under the curve for cardiac troponin I compared to saline (MD -86.2; 95% CI -172.3 to -0.1; P=0.03).
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