Volatile anesthetics versus total intravenous anesthesia for cardiac surgery

Giovanni Landoni, Vladimir V. Lomivorotov, Caetano Nigro Neto, Fabrizio Monaco, Vadim V. Pasyuga, Nikola Bradic, Rosalba Lembo, Gordana Gazivoda, Valery V. Likhvantsev, Chong Lei, Andrey Lozovskiy, Nora Di Tomasso, A. R.Bukamal Nazar, Fernanda S. Silva, Andrey E. Bautin, Jun Ma, Martina Crivellari, Ahmed M.G.A. Farag, Nikolay S. Uvaliev, Cristiana CarolloMarina Pieri, Jan Kunstýř, Chew Yin Wang, Alessandro Belletti, Ludhmila A. Hajjar, Evgeny V. Grigoryev, Felice E. Agrò, Hynek Riha, Mohamed R. El-Tahan, A. Mara Scandroglio, Abeer M. Elnakera, Massimo Baiocchi, Paolo Navalesi, Vladimir A. Shmyrev, Luca Severi, Mohammed A. Hegazy, Giuseppe Crescenzi, Dmitry N. Ponomarev, Luca Brazzi, Renato Arnoni, Dmitry G. Tarasov, Miomir Jovic, Maria G. Calabrò, Tiziana Bove, Rinaldo Bellomo, Alberto Zangrillo

Research output: Contribution to journalArticle

Abstract

BACKGROUND Volatile (inhaled) anesthetic agents have cardioprotective effects, which might improve clinical outcomes in patients undergoing coronary-artery bypass grafting (CABG). METHODS We conducted a pragmatic, multicenter, single-blind, controlled trial at 36 centers in 13 countries. Patients scheduled to undergo elective CABG were randomly assigned to an intraoperative anesthetic regimen that included a volatile anesthetic (desflurane, isoflurane, or sevoflurane) or to total intravenous anesthesia. The primary outcome was death from any cause at 1 year. RESULTS A total of 5400 patients were randomly assigned: 2709 to the volatile anesthetics group and 2691 to the total intravenous anesthesia group. On-pump CABG was performed in 64% of patients, with a mean duration of cardiopulmonary bypass of 79 minutes. The two groups were similar with respect to demographic and clinical characteristics at baseline, the duration of cardiopulmonary bypass, and the number of grafts. At the time of the second interim analysis, the data and safety monitoring board advised that the trial should be stopped for futility. No significant difference between the groups with respect to deaths from any cause was seen at 1 year (2.8% in the volatile anesthetics group and 3.0% in the total intravenous anesthesia group; relative risk, 0.94; 95% confidence interval [CI], 0.69 to 1.29; P=0.71), with data available for 5353 patients (99.1%), or at 30 days (1.4% and 1.3%, respectively; relative risk, 1.11; 95% CI, 0.70 to 1.76), with data available for 5398 patients (99.9%). There were no significant differences between the groups in any of the secondary outcomes or in the incidence of prespecified adverse events, including myocardial infarction. CONCLUSIONS Among patients undergoing elective CABG, anesthesia with a volatile agent did not result in significantly fewer deaths at 1 year than total intravenous anesthesia.

Original languageEnglish
Pages (from-to)1214-1225
Number of pages12
JournalNew England Journal of Medicine
Volume380
Issue number13
DOIs
Publication statusPublished - Mar 28 2019

ASJC Scopus subject areas

  • Medicine(all)

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    Landoni, G., Lomivorotov, V. V., Neto, C. N., Monaco, F., Pasyuga, V. V., Bradic, N., Lembo, R., Gazivoda, G., Likhvantsev, V. V., Lei, C., Lozovskiy, A., Di Tomasso, N., Nazar, A. R. B., Silva, F. S., Bautin, A. E., Ma, J., Crivellari, M., Farag, A. M. G. A., Uvaliev, N. S., ... Zangrillo, A. (2019). Volatile anesthetics versus total intravenous anesthesia for cardiac surgery. New England Journal of Medicine, 380(13), 1214-1225. https://doi.org/10.1056/NEJMoa1816476