| Determinants of low systemic vascular resistance during cardiopulmonary bypass. | |
| | |
MedLine Citation:
|
PMID: 7944747 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
Although low systemic vascular resistance occurs during normothermic and hypothermic cardiopulmonary bypass, the determinants of depressed systemic vascular resistance and its effect on outcomes are unknown. To assess the predictors and clinical effects of low systemic vascular resistance, 555 patients undergoing isolated coronary artery bypass grafting were evaluated prospectively. The extent of low systemic vascular resistance during bypass was estimated by the amount of the vasoconstrictor phenylephrine administered: group 1, 0 to 160 micrograms; group 2, 161 to 800 micrograms; group 3, more than 800 micrograms. Multivariate analysis identified bypass temperature, bypass time, and ventricular function as determinants of low systemic vascular resistance. Patients on normothermic bypass accounted for 65% of the patients in group 3 and only 34% of the patients in group 1 (p < 0.0001). The bypass time was longer in the patients in group 3 (97 +/- 28 minutes) than in the patients in group 1 (89 +/- 24 minutes; p < 0.006). Patients with a preoperative left ventricular ejection fraction of 0.40 or less required less phenylephrine during cardiopulmonary bypass (498 +/- 68 micrograms) than did patients with a fraction exceeding 0.40 (1,087 +/- 88 micrograms; p < 0.001). By multivariate analysis, advanced age and the presence of peripheral vascular disease were found to decrease the likelihood of low systemic vascular resistance during normothermic bypass. Diabetes, the left ventricular ejection fraction, the bypass time, and the total cardioplegia infused were found to influence the likelihood of low systemic vascular resistance during hypothermic bypass. Patients in group 3 had a higher cardiac index and lower-mean arterial pressure and systemic vascular resistance postoperatively. In those patients who received a left internal mammary artery graft, the incidences of the low-output syndrome (group 1, 4.9%; group 3, 2.7%; p = not significant) and myocardial infarction (group 1, 1.4%; group 3, 1.8%; p = not significant) were not influenced by the amount of phenylephrine infused during cardiopulmonary bypass. In those patients who were at high risk of suffering a stroke preoperatively, the hypotension induced by the low systemic vascular resistance and its treatment with phenylephrine was not associated with an increased incidence of stroke (group 1, 5.8%; group 3, 2.8%; p = not significant). |
| | |
Authors:
|
G T Christakis; S E Fremes; J P Koch; S Harwood; S Juhasz; E Sharpe; K A Deemar; C Hamilton; E Chen; V Rao |
Related Documents
:
|
12440607 - Changing pattern in beating heart operations: use of skeletonized internal thoracic art... 3872967 - Practical problems in assessing risk for coronary artery bypass grafting. 17336717 - Improved noninvasive assessment of coronary artery bypass grafts with 64-slice computed... 17301637 - Predictors of coronary bypass grafting in a population of middle-aged men. 20413657 - Plasma levels of fibrinolytic proteins and the risk of myocardial infarction in men. 10617007 - Can technetium 99m pyrophosphate be used to quantify myocardial injury in donor hearts? |
Publication Detail:
|
Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
|
Title: The Annals of thoracic surgery Volume: 58 ISSN: 0003-4975 ISO Abbreviation: Ann. Thorac. Surg. Publication Date: 1994 Oct |
Date Detail:
|
Created Date: 1994-11-10 Completed Date: 1994-11-10 Revised Date: 2006-11-15 |
Medline Journal Info:
|
Nlm Unique ID: 15030100R Medline TA: Ann Thorac Surg Country: UNITED STATES |
Other Details:
|
Languages: eng Pagination: 1040-9 Citation Subset: AIM; IM |
Affiliation:
|
Division of Cardiovascular Surgery and Clinical Epidemiology Unit, Sunnybrook Health Science Centre, University of Toronto, Ontario, Canada. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Aged Blood Pressure / drug effects Body Temperature Cardioplegic Solutions Coronary Artery Bypass* Diabetes Mellitus / physiopathology Female Humans Male Middle Aged Morbidity Multivariate Analysis Peripheral Vascular Diseases / physiopathology Phenylephrine / pharmacology Postoperative Complications Prospective Studies Risk Factors Vascular Resistance* Ventricular Dysfunction, Left / physiopathology |
| Chemical | |
Reg. No./Substance:
|
0/Cardioplegic Solutions; 59-42-7/Phenylephrine |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Treatment of acute pulmonary hypertension with inhaled nitric oxide.
Next Document: Cardiac transplant donor heart allocation based on prospective tissue matching.