Background: This study investigated the influence of volatile
anesthesia (VA) on major complications and mortality in patients undergoing
coronary artery bypass graft surgery (CABG). Methods: This post-hoc
analysis included 1586 patients from the MYRIAD trial managed using the same
perioperative protocol at a single institution. Patients were randomized to
receive either volatile anesthesia (sevoflurane, isoflurane, or desflurane) or
total intravenous anesthesia (TIVA). The assessed study outcomes were the rate of
complications, including: myocardial infarction, stroke, acute kidney injury,
prolonged ventilation (24 h), receipt of high-dose inotropic support
(inotropic score 10), and need for mechanical circulatory support. The
duration of intensive care unit (ICU) stay, length of hospitalization, hospital
readmission during follow-up, 30-days and 1-year mortality were also analyzed.
Results: 1586 patients were enrolled between September 2014–September
2017 and randomly assigned to the volatile anesthesia group (n = 794) and the
TIVA group (n = 792). The median patient age was 63 years, with a median ejection
fraction of 60%. There were no significant differences in the rates of major
complications, duration of ICU stay, and hospitalization between the groups. The
median total dose of fentanyl was 12.0 mcg/kg in volatile group and 14.4 mcg/kg
in TIVA group (p 0.001). One-year mortality rates were 2.5% (n =
20) and 3.2% (n = 25) in the volatile and TIVA groups, respectively. Two
patients were lost at the 30-day and 1-year follow-ups in the volatile group
compared to four patients in TIVA group. Regression analysis showed that
cardiopulmonary bypass (CPB) duration, fentanyl dose, and baseline serum
creatinine level were associated with 30-days mortality, while ejection fraction
was associated with 1-year mortality. Conclusions: The use of VA in
patients undergoing CABG did not result in a reduction in major complications or
mortality compared with TIVA. A higher dose of fentanyl was used in the TIVA
group and was associated with an increase in the 30-days mortality. These
findings warrant further investigation. Clinical Trial Registration: ClinicalTrials.gov (NCT02105610).