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A prospective randomized study to evaluate stress response during beating-heart and conventional coronary revascularization

A prospective randomized study to evaluate stress response during beating-heart and conventional coronary revascularization
A prospective randomized study to evaluate stress response during beating-heart and conventional coronary revascularization
Background: Cardiopulmonary bypass (CPB) is associated with a systemic stress hormonal response, which can lead to changes in hemodynamics and organ perfusion. We examined perioperative stress hormone release in low-risk patients undergoing coronary artery bypass grafting with and without cardiopulmonary bypass.
Methods: Fifty-two patients undergoing primary coronary artery bypass grafting by the same surgeon were randomly assigned into either on-pump (n = 26) or off-pump (n = 26) groups. The on-pump coronary artery bypass grafting group underwent mildly hypothermic (35°C) pulsatile cardiopulmonary bypass with arterial line filtration. Arterial blood samples were collected preoperatively, at the end of operation, and at 1, 6, and 24 hours postoperatively. Plasma levels of vasopressin and cortisol were measured using radioimmunoassay. Anesthetic management was standardized.
Results: Both groups had similar demographic makeup and extent of revascularization (on-pump coronary artery bypass grafting, 2.8 ± 1.0 grafts versus off-pump coronary artery bypass grafting, 2.4 ± 0.9 grafts; p = 0.20). No mortality or major morbidity was observed and there were no crossovers. The cardiopulmonary bypass and aortic cross-clamp times in the on-pump coronary artery bypass grafting group were 63 ± 24 and 33 ± 11 minutes, respectively. In both groups there was a similar and significant rise in cortisol and vasopressin levels in the early postoperative phase, with a partial recovery toward baseline values observed at 24 hours postoperatively. Repeated measures analysis of covariance showed no significant difference between the groups with time for both hormones (cortisol, p = 0.40; vasopressin, p = 0.30).
Conclusions: Despite the avoidance of cardiopulmonary bypass, off-pump coronary artery bypass grafting surgery triggers a systemic stress hormone response that is comparable to conventional surgical revascularization. The neurohormonal environment during beating-heart surgery should be further explored.
0003-4975
506-512
Velissaris, Theodore
731d89bf-8c7a-4e68-ab6c-61e815d94415
Tang, Augustine T.M.
2f44db5d-b12a-4911-b269-3f68b4d82a82
Murray, Matthew
4782421a-af26-40b9-8fcd-087ac1959854
Mehta, Rajnikant L.
b8db4d9d-053c-4926-9ef0-fa3a8f0e743e
Wood, Peter J.
30039979-9541-4a0a-8aef-0dfe53114e02
Hett, David A.
b05d7d54-3a3d-44df-9bee-8494934f3364
Ohri, Sunil K.
8aa5698c-78cf-4f59-a5af-5afa46f0348c
Velissaris, Theodore
731d89bf-8c7a-4e68-ab6c-61e815d94415
Tang, Augustine T.M.
2f44db5d-b12a-4911-b269-3f68b4d82a82
Murray, Matthew
4782421a-af26-40b9-8fcd-087ac1959854
Mehta, Rajnikant L.
b8db4d9d-053c-4926-9ef0-fa3a8f0e743e
Wood, Peter J.
30039979-9541-4a0a-8aef-0dfe53114e02
Hett, David A.
b05d7d54-3a3d-44df-9bee-8494934f3364
Ohri, Sunil K.
8aa5698c-78cf-4f59-a5af-5afa46f0348c

Velissaris, Theodore, Tang, Augustine T.M., Murray, Matthew, Mehta, Rajnikant L., Wood, Peter J., Hett, David A. and Ohri, Sunil K. (2004) A prospective randomized study to evaluate stress response during beating-heart and conventional coronary revascularization. The Annals of Thoracic Surgery, 78 (2), 506-512. (doi:10.1016/S0003-4975(03)01360-2).

Record type: Article

Abstract

Background: Cardiopulmonary bypass (CPB) is associated with a systemic stress hormonal response, which can lead to changes in hemodynamics and organ perfusion. We examined perioperative stress hormone release in low-risk patients undergoing coronary artery bypass grafting with and without cardiopulmonary bypass.
Methods: Fifty-two patients undergoing primary coronary artery bypass grafting by the same surgeon were randomly assigned into either on-pump (n = 26) or off-pump (n = 26) groups. The on-pump coronary artery bypass grafting group underwent mildly hypothermic (35°C) pulsatile cardiopulmonary bypass with arterial line filtration. Arterial blood samples were collected preoperatively, at the end of operation, and at 1, 6, and 24 hours postoperatively. Plasma levels of vasopressin and cortisol were measured using radioimmunoassay. Anesthetic management was standardized.
Results: Both groups had similar demographic makeup and extent of revascularization (on-pump coronary artery bypass grafting, 2.8 ± 1.0 grafts versus off-pump coronary artery bypass grafting, 2.4 ± 0.9 grafts; p = 0.20). No mortality or major morbidity was observed and there were no crossovers. The cardiopulmonary bypass and aortic cross-clamp times in the on-pump coronary artery bypass grafting group were 63 ± 24 and 33 ± 11 minutes, respectively. In both groups there was a similar and significant rise in cortisol and vasopressin levels in the early postoperative phase, with a partial recovery toward baseline values observed at 24 hours postoperatively. Repeated measures analysis of covariance showed no significant difference between the groups with time for both hormones (cortisol, p = 0.40; vasopressin, p = 0.30).
Conclusions: Despite the avoidance of cardiopulmonary bypass, off-pump coronary artery bypass grafting surgery triggers a systemic stress hormone response that is comparable to conventional surgical revascularization. The neurohormonal environment during beating-heart surgery should be further explored.

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Published date: 2004

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Local EPrints ID: 25011
URI: http://eprints.soton.ac.uk/id/eprint/25011
ISSN: 0003-4975
PURE UUID: abf5e8b3-cb51-470d-abdf-a4f4fc994e69

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Date deposited: 05 Apr 2006
Last modified: 15 Mar 2024 06:59

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Contributors

Author: Theodore Velissaris
Author: Augustine T.M. Tang
Author: Matthew Murray
Author: Rajnikant L. Mehta
Author: Peter J. Wood
Author: David A. Hett
Author: Sunil K. Ohri

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