Document Detail


Response of mean arterial pressure to temporary biventricular pacing after chest closure during cardiac surgery.
MedLine Citation:
PMID:  22920599     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: We have previously demonstrated that biventricular pacing increased cardiac output within 1 hour of weaning from cardiopulmonary bypass in selected patients. To assess the possible sustained benefit, we reviewed in the present study the effects of biventricular pacing on the mean arterial pressure after chest closure.
METHODS: A total of 30 patients (mean ejection fraction 35% ± 15%, mean QRS 119 ± 24 ms) underwent coronary bypass and/or valve surgery. The mean arterial pressure was maximized during biventricular pacing using atrioventricular delays of 90 to 270 ms and interventricular delays of +80 to -80 ms during 20-second intervals in random sequence. Optimized biventricular pacing was finally compared with atrial pacing at a matched heart rate and to a sinus rhythm during 30-second intervals. Vasoactive medication and fluid infusion rates were held constant. The arterial pressure was digitized, recorded, and integrated. Statistical significance was assessed using linear mixed effects models and Bonferroni's correction.
RESULTS: Optimized atrioventricular delay, ranging from 90 to 270 ms, increased the mean arterial pressure 4% versus nominal and 7% versus the worst (P < .001). Optimized interventricular delay increased pressure 3% versus nominal and 7% versus the worst. Optimized biventricular pacing increased the mean arterial pressure 4% versus sinus rhythm (78.5 ± 2.4 vs 75.1 ± 2.4 mm Hg; P = .002) and 3% versus atrial pacing (76.4 ± 2.7 mm Hg; P = .017).
CONCLUSIONS: Temporary biventricular pacing improves the hemodynamics after chest closure, with effects similar to those within 1 hour of bypass. Individualized optimization of atrioventricular delay is warranted, because the optimal delay was longer in 80% of our patients than the current recommendations for temporary postoperative pacing.
Authors:
Benjamin J Rubinstein; Daniel Y Wang; Santos E Cabreriza; Bin Cheng; Linda Aponte-Patel; Alexandra Murata; Alexander Rusanov; Marc E Richmond; T Alexander Quinn; Henry M Spotnitz
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural     Date:  2012-08-21
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  144     ISSN:  1097-685X     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-11-12     Completed Date:  2013-01-22     Revised Date:  2014-11-07    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1445-52     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2012 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00498940
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MeSH Terms
Descriptor/Qualifier:
Aged
Arterial Pressure*
Cardiac Resynchronization Therapy* / methods
Cardiac Surgical Procedures* / adverse effects
Coronary Artery Bypass
Female
Heart Conduction System / physiopathology*
Heart Rate
Heart Valves / surgery
Humans
Linear Models
Male
Middle Aged
New York City
Postoperative Care
Postoperative Complications / etiology,  physiopathology,  prevention & control*
Sternotomy
Stroke Volume
Time Factors
Treatment Outcome
Ventricular Function, Left
Wound Closure Techniques*
Grant Support
ID/Acronym/Agency:
5 T32 GM008464-17/GM/NIGMS NIH HHS; R01 HL080152/HL/NHLBI NIH HHS; R01 HL080152/HL/NHLBI NIH HHS; T32 HL007854/HL/NHLBI NIH HHS; T35 HL007616/HL/NHLBI NIH HHS
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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