De Hert, Stefaan

HUYS, JEROEN

Vacman Study Group,

Wouters, Patrick

Vacman Study Group, -

Ghent University Academic Bibliography

Anesthetic cardioprotection in coronary artery surgery? The results of the Volatile Anesthetics and Cardioprotection Multicentre ANalysis (VACMAN)Jeroen Huys, MD1; Stefan G. De Hert, MD2, Ph.D; Patrick F. Wouters, MD1, Ph.D; the VACMAN study group*1 Department of Anesthesia, Ghent University Hospital , Belgium2 University of Amsterdam, Academic Medical Center, Amsterdam, The NetherlandsIntroductionExperimental data show that volatile anestheticsprotect against the consequences of reversiblemyocardial ischemia and reperfusion injury.Clinical studies have been mainly monocentric withinconsistent results.ResultsTROP T MAX(P=0.3343 NS)MULTIVARIATEHOSPITAL LENGTH OF STAY(P = 0.0213)MULTIVARIATEONE-YEAR MORTALITY(P = 0.0475)UNIVARIATEHypothesis: the use of a volatile anesthetic regimenis associated with less postoperative myocardialdamage, as evidenced by a lowertroponin T release.MethodsMulticentre Randomized controlled trial:8 participating centres in Flanders, Belgium Mortality curves of the 3 different study groups at 1, 3 and 12 months:Intravenous(Group 1)0,75 ± 1,42 ng.mL-111 days (range 5 to 87 days)7,4 %Sevoflurane(Group 2)0,57 ± 1,03 ng.mL-19 days (range 5 to 61 days)2,5 %Desflurane(Group 3)0,46 ± 0,46 ng.mL-110 days (range 5 to 54 days)2,8 %Regimen for administration of volatile anesthetics:starting at a minimal end-tidal concentration of 0,5MAC at least 30 minutes before the initiation ofmyocardial ischemia to at least 10 minutes after thebeginning of reperfusion.Primary outcome variable: myocardial celldamage quantified by the area under the curve forcardiac troponin T blood concentrations over thefirst 24 hrs (AUC24hr) and the peak level of troponinT (Tmax)Secondary outcome variables: length of hospitalstay ; 30-day and 1-year mortalityConclusionThe results of this multicenter study on 673 coronary surgerypatients could not demonstrate a lower postoperativetroponin T release when using a volatile anesthetic regimen(sevoflurane or desflurane) compared with a totalintravenous anesthetic regimen. However, the use of avolatile anesthetic regimen seemed to be associated with ashorter hospital length of stay and there was a tendency fora lower one-year mortality.*VACMAN study group = Jeroen Huys, Patrick Wouters, Ghent University Hospital, Ghent; Dirk Vlasselaers, Patrick Wouters,  University Hospitals Leuven, Leuven; Stefan De Hert, University Hospital Antwerp, Antwerp and University of Amsterdam, Amsterdam; Rob Barbé, Imelda Hospital, Bonheiden; Jean-Paul Ory, Jan Dewandere, Virga Jesse Hospital, Hasselt; Dirk De Kegel, Bruno Verhamme, Heilig Hart Hospital, Roeselare; Ruggero Donadonni, Eef Delombaerde, Maria Middelares Hospital, Ghent; Jean-Luc Demeere, Sint Jan Hospital, Brussels; Jan Mulier, Eric Schelstraete, Sint Jan Hospital, Bruges.

Anesthetic cardioprotection in coronary artery surgery? The results of the Volatile Anesthetics and Cardioprotection multicentre ANalysis (VACMAN)

https://biblio.ugent.be/publication/849084/file/858101

Anesthetic cardioprotection in coronary artery surgery? The results of the Volatile Anesthetics and Cardioprotection multicentre ANalysis (VACMAN)

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