Abstract
Despite numerous previous studies, there is little data on the effects of anesthetics on clinical outcome after off-pump coronary arterial bypass grafting (OPCAB). Therefore, we retrospectively compared the effects of anesthetic choice on in-hospital major adverse events (MAEs) and one-year major adverse cardiovascular and cerebral events (MACCEs) in patients undergoing OPCAB. Electronic medical records were reviewed in 192 patients who received propofol-remifenanil total intravenous anesthesia (TIVA) and propensity score-matched 662 patients who received isoflurane anesthesia. The primary endpoints were in-hospital MAEs and one-year MACCEs. The components of in-hospital MAEs were in-hospital death, myocardial infarction (MI), coronary revascularization, stroke, renal failure, prolonged mechanical ventilation longer than 72 h, and postoperative new cardiac arrhythmia requiring treatment. One-year MACCEs was defined as a composite of all-cause mortality, MI, coronary revascularization, and stroke. There was no significant difference in risk of in-hospital MAEs (OR = 1.29, 95% CI = 0.88–1.88, P = 0.20) or one-year MACCEs (OR = 0.81; 95% CI = 0.46–1.42, P = 0.46) between the groups. The risk of postoperative new arrhythmia including new atrial fibrillation significantly increased in the TIVA group compared to the isoflurane anesthesia group (OR = 1.72, 95% CI = 1.12–2.63, P = 0.01). In conclusion, the choice between propofol-remifentanil TIVA and isoflurane anesthesia did not show differences in incidence of in-hospital MAEs or one-year MACCEs in patients undergoing OPCAB. However, further studies on the effects of anesthetics on development of in-hospital new arrhythmia will be needed.
Highlights
In current clinical practice, a volatile agent or propofol-remifentanil are the most frequently chosen anesthetic drugs for cardiac surgeries
After one-to-many matching according to propensity score, 192 patients who received total intravenous anesthesia (TIVA) were matched with 662 patients who received isoflurane anesthesia, for a total of 854 patients (Fig 1)
The two groups contained some mismatched baseline characteristics including sex, body mass index (BMI), previous stroke, presence of three-vessel disease, and usage of angiotensin receptor blocker before propensity score matching; there were no significant differences in any variables between the study groups in the propensity score-matched cohort (Table 1)
Summary
A volatile agent or propofol-remifentanil are the most frequently chosen anesthetic drugs for cardiac surgeries. All of these agents have been suggested to have cardio-protective effects against ischemia/reperfusion (I/R) injury through different mechanisms. Numerous studies have investigated the protective effects of anesthetics in cardiac surgeries using cardiopulmonary bypass (CPB), which is accompanied by profound systemic I/R injury [4, 8, 10,11,12,13]. The protective effects of anesthetics in OPCAB need to be studied separately from on-pump cardiac surgeries. Previous research on OPCAB has mainly focused on changes in postoperative cardiac biomarkers and has shown limited clinical outcomes [3, 5, 9, 14, 15]
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