Sevoflurane alleviates myocardial ischemia/reperfusion injury via actitation of heat shock protein-70 in patients undergoing double valve replacement surgery.

This study investigated the cardioprotective effect(s) of sevoflurane in rheumatic heart disease patients undergoing double valve replacement surgery (DVRS) under cardiopulmonary bypass (CPB) and its potential mechanisms (ChiCTR2100051220 on http://www.ChiCTR.org.cn). Forty-six patients were randomly assigned to undergo propofol or sevoflurane anesthesia during surgery. The levels of myocardial injury markers, inflammatory cytokines, heat shock protein-70 (HSP70), and superoxide dismutase (SOD) activity were measured from blood samples. Mean arterial pressure, cardiac index, and stroke volume index were significantly higher in the sevoflurane group than in the propofol group at the end of CPB. However, there were no significant differences in operative duration, length of CPB or aortic cross-clamp time, auto-resuscitation heart rate, drainage within 48 h after surgery, time to extubation, and recovery time after DVRS. The dose of inotropic agents (dopamine and noradrenaline) was significantly lower in the sevoflurane group than in the propofol group. Sevoflurane was associated with smaller increases in the levels of myocardial injury-associated markers (CK-MB and cardiac troponin I [cTnI]) and inflammatory cytokines (interleukin [IL]-6, IL-8, and tumor-necrosis factor-alpha [TNF-α]); however, there was a greater increase in HSP70 levels compared with propofol after surgery. Moreover, SOD activity after surgery was significantly higher in the sevoflurane group than in the propofol group. Increased HSP70 levels in the sevoflurane group were positively correlated with cTnI, IL-6, IL-8, and TNF-α levels, and negatively correlated with SOD activity. These results suggest a cardioprotective effect of sevoflurane during DVRS. Sevoflurane may reduce biomarkers of cardiac injury through its anti-inflammatory effects via upregulation of HSP70.