A Multimodal Cardioprotection Strategy During Cardiac Surgery: The ProCCard Study

Area of Science:

• Cardiology
• Anesthesiology
• Cardiovascular Surgery

Background:

• Cardiac surgery poses risks of myocardial and biological damage.
• Perioperative interventions are explored to mitigate these risks.
• Multimodal cardioprotection strategies aim to improve patient outcomes.

Purpose of the Study:

• To evaluate the efficacy of a combined perioperative cardioprotective strategy in reducing myocardial and other damage during cardiac surgery.
• To assess the impact of multimodal cardioprotection on biological markers and clinical events post-surgery.

Main Methods:

• Prospective, randomized, controlled trial involving 210 patients undergoing aortic valve surgery.
• Interventions included sevoflurane anesthesia, remote ischemic preconditioning, glucose control, moderate respiratory acidosis, and gentle reperfusion.
• Compared a control group (standard care) with a treated group receiving the multimodal intervention.

Main Results:

• The multimodal strategy did not significantly reduce the primary outcome, 72-h area under the curve for high-sensitivity cardiac troponin I (hsTnI).
• No significant differences were observed in the rate of adverse events or postoperative renal failure between groups.
• A non-significant reduction in hsTnI was noted with sevoflurane use, and the relationship between hsTnI and aortic clamping time was unaffected by the treatment.

Conclusions:

• Multimodal cardioprotection combining five techniques did not demonstrate significant biological or clinical benefits in this cardiac surgery cohort.
• The potential cardio- and reno-protective effects of sevoflurane and remote ischemic preconditioning require further investigation in this setting.