Effect of Xenon Anesthesia Compared to Sevoflurane and Total Intravenous Anesthesia for Coronary Artery Bypass Graft Surgery on Postoperative Cardiac Troponin Release

Jan Hofland, Alexandre Ouattara, Jean-Luc Fellahi, Matthias Gruenewald, Jean Hazebroucq, Claude Ecoffey, Pierre Joseph, Matthias Heringlake, Annick Steib, Mark Coburn, Julien Amour, Bertrand Rozec, Inge de Liefde, Patrick Meybohm, Benedikt Preckel, Jean-Luc Hanouz, Luigi Tritapepe, Peter Tonner, Hamina Benhaoua, Jan Patrick Roesner, Berthold Bein, Luc Hanouz, Rob Tenbrinck, Ad J J C Bogers, Bert G Mik, Alain Coiffic, Jochen Renner, Markus Steinfath, Helga Francksen, Ole Broch, Assad Haneya, Manuella Schaller, Patrick Guinet, Lauren Daviet, Corinne Brianchon, Sebastien Rosier, Jean-Jacques Lehot, Hauke Paarmann, Julika Schön, Thorsten Hanke, Joachym Ettel, Silke Olsson, Stefan Klotz, Amir Samet, Giedrius Laurinenas, Adrien Thibaud, Mircea Cristinar, Olivier Collanges, François Levy, Rolf Rossaint, Ana Stevanovic, Gereon Schaelte, Christian Stoppe, Nora Ait Hamou, Sarah Hariri, Astrid Quessard, Aude Carillion, Hélène Morin, Jacqueline Silleran, David Robert, Anne-Sophie Crouzet, Kai Zacharowski, Christian Reyher, Sonja Iken, Nina C Weber, Marcus Hollmann, Susanne Eberl, Giovanni Carriero, Daria Collacchi, Alessandra Di Persio, Olivier Fourcade, Stefan Bergt, Angela Alms

Ischemic myocardial damage accompanying coronary artery bypass graft surgery remains a clinical challenge. We investigated whether xenon anesthesia could limit myocardial damage in coronary artery bypass graft surgery patients, as has been reported for animal ischemia models. In 17 university hospitals in France, Germany, Italy, and The Netherlands, low-risk elective, on-pump coronary artery bypass graft surgery patients were randomized to receive xenon, sevoflurane, or propofol-based total intravenous anesthesia for anesthesia maintenance. The primary outcome was the cardiac troponin I concentration in the blood 24 h postsurgery. The noninferiority margin for the mean difference in cardiac troponin I release between the xenon and sevoflurane groups was less than 0.15 ng/ml. Secondary outcomes were the safety and feasibility of xenon anesthesia. The first patient included at each center received xenon anesthesia for practical reasons. For all other patients, anesthesia maintenance was randomized (intention-to-treat: n = 492; per-protocol/without major protocol deviation: n = 446). Median 24-h postoperative cardiac troponin I concentrations (ng/ml [interquartile range]) were 1.14 [0.76 to 2.10] with xenon, 1.30 [0.78 to 2.67] with sevoflurane, and 1.48 [0.94 to 2.78] with total intravenous anesthesia [per-protocol]). The mean difference in cardiac troponin I release between xenon and sevoflurane was -0.09 ng/ml (95% CI, -0.30 to 0.11; per-protocol: P = 0.02). Postoperative cardiac troponin I release was significantly less with xenon than with total intravenous anesthesia (intention-to-treat: P = 0.05; per-protocol: P = 0.02). Perioperative variables and postoperative outcomes were comparable across all groups, with no safety concerns. In postoperative cardiac troponin I release, xenon was noninferior to sevoflurane in low-risk, on-pump coronary artery bypass graft surgery patients. Only with xenon was cardiac troponin I release less than with total intravenous anesthesia. Xenon anesthesia appeared safe and feasible.