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Cardiaoprotective effect of sevoflurane preconditioning in patients undergoing mitral replacement surgery: a randomized controlled trial with lncRNA analysis



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Cardiaoprotective effect of sevoflurane preconditioning in patients undergoing mitral replacement surgery: a randomized controlled trial with lncRNA analysis


CHEN Hong DUAN Zhenxin CHEN Feng DUAN Guangyou CHEN Fang ZHONG Hejiang DU Zhiyong LI Hong

Department of Anesthesiology, Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400037, China


sevoflurane mitral valve replacement cardioprotection long noncoding RNA

ObjectiveTo investigate the cardioprotective effects of sevoflurane preconditioning in patients undergoing mitral valve replacement under cardiopulmonary bypass and explore the underlying mechanisms by analyzing the expression profile of long noncoding RNAs (lncRNAs) in human cardiac tissue. MethodsThis randomized controlled trial included a total of 40 patients [17 male and 23 female patients with a mean age of 48 years (median, 49 years) and a mean body mass index of 22.7±2.6 kg/m2] undergoing mitral valve replacement under cardiopulmonary bypass between May and November 2017. The patients were randomized to undergo mitral valve replacement with sevoflurane preconditioning before cardiopulmonary bypass (SEV group, n=20) or without sevoflurane preconditioning (control group, n=20). Serum levels of cardiac troponin I (cTnI) was tested before and at 2 h and 24 h after surgery, and the left ventricular fractional shortening and ejection fraction were determined by cardiac ultrasonography before and at 24 h after surgery. The length of postoperative ICU stay and length of hospital stay of the patients were recorded. For 5 patients from each group, RNAseq analysis was performed using the left atrial myocardial specimens collected during the surgery. ResultsCompared with those in the control group, the patients in SEV group had significantly lower serum levels of cTnI at 2 h [1.06 (0.55, 2.16) vs 0.58 (0.33, 0.90) ng/mL, P<0.05] and at 24 h after the surgery [1.09 (0.72, 1.54) vs 0.66 (0.38, 1.02) ng/mL, P<0.05]. At 24 h after the surgery, the patients in SEV group showed significantly higher values of both fractional shortening [(39.8±3.3)% vs (33.9±2.8)%, P<0.05] and ejection fraction [(70.5±4.0)% vs (62.7±4.2)%, P<0.05] than those in the control group. The length of ICU stay was significantly shorter in SEV group than in the control group (68±18 vs 83±26 h, P<0.05), but the length of hospital stay did not differ significantly between the 2 groups (P>0.05). The results of lncRNA analysis identified 73 upregulated lncRNAs and 95 downregulated lncRNAs in the myocardial specimens, and KEGG analysis suggested possible associations of several apoptosisrelated pathways with the cardioprotective effects of sevoflurane preconditioning. ConclusionSevoflurane preconditioning before cardiopulmonary bypass can reduce myocardial injury early after mitral valve replacement, and thus can be an optimal anesthesia strategy for this operation. The lncRNA pathways in relation with apoptosis may provide new insights into the mechanism of cardioprotective effects of sevoflurane preconditioning.


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Last Update: 2018-07-03