Document Detail

Low systemic vascular resistance state following off-pump coronary artery bypass grafting.
MedLine Citation:
PMID:  18292734     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To determine the prevalence, hemodynamic characteristics, and risk factors for low systemic vascular resistance (SVR) state following after off-pump coronary artery bypass (OPCAB). PATIENTS AND METHODS: SVR data could be obtained for 116 OPCAB patients. Low SVR was defined as an indexed systemic vascular resistance (SVRi) of <1,800 dyne x s/cm(5) x m(2) at the end of operation. Hemodynamic data were recorded preoperatively, at the end of operation, just after entering ICU, and the following morning. RESULTS: Low SVR state was noted in 54 of 116 patients (53%). The SVRi values in low-SVR and non-low-SVR patients were 1,406+/-253 and 2,326+/-509 dyne x s/cm(5) x m(2) at the end of operation (p<0.0001). Increased CI level, decreased MAP level, but unchanged CVP level was observed postoperatively in the low-SVR patients. The increase in CI and decrease in MAP were maximal at the end of operation. Patients with low SVR were more likely to have a higher body mass index (24.5+/-3.6 vs. 22.9+/-2.9; p=0.013) and to be male (82% vs. 62%; p=0.036) than no-low-SVR patients. In low-SVR patients, fluid balance was more positive intraoperatively (3,537+/-1,411 vs. 3,068+/-1,597; p=0.09), but more negative at 6 hours postoperatively (-136+/-978 vs. 234+/-844; p=0.034) and 12 h postoperatively (-282+/-1,321 vs. 268+/-1,238; p=0.024). CONCLUSIONS: Low SVR state, a probable manifestation of systemic inflammatory response (SIRS), is common in patients who have undergone OPCAB. For these patients it is more reasonable to maintain MAP with vasopressors by restoring vascular tone, than by volume loading.
Kaoru Matsuura; Mizuho Imamaki; Atsushi Ishida; Hitoshi Shimura; Hisanori Fujita; Yuriko Niitsuma; Masaru Miyazaki
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia     Volume:  14     ISSN:  1341-1098     ISO Abbreviation:  Ann Thorac Cardiovasc Surg     Publication Date:  2008 Feb 
Date Detail:
Created Date:  2008-02-22     Completed Date:  2008-05-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9703158     Medline TA:  Ann Thorac Cardiovasc Surg     Country:  Japan    
Other Details:
Languages:  eng     Pagination:  15-21     Citation Subset:  IM    
Division of Cardiovascular Surgery, Department of Surgery, Chiba University Hospital, Chiba, Japan.
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MeSH Terms
Chi-Square Distribution
Coronary Artery Bypass, Off-Pump / adverse effects*
Retrospective Studies
Risk Factors
Statistics, Nonparametric
Vascular Resistance*

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