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A prospective randomized study to evaluate stress response during beating-heart and conventional coronary revascularization.
Ann Thorac Surg. 2004 Aug; 78(2):506-12; discussion 506-12.AT

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 degrees 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.

Authors+Show Affiliations

Wessex Cardiothoracic Centre, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, United Kingdom. theo@velissaris.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15276508

Citation

Velissaris, Theodore, et al. "A Prospective Randomized Study to Evaluate Stress Response During Beating-heart and Conventional Coronary Revascularization." The Annals of Thoracic Surgery, vol. 78, no. 2, 2004, pp. 506-12; discussion 506-12.
Velissaris T, Tang AT, Murray M, et al. A prospective randomized study to evaluate stress response during beating-heart and conventional coronary revascularization. Ann Thorac Surg. 2004;78(2):506-12; discussion 506-12.
Velissaris, T., Tang, A. T., Murray, M., Mehta, R. L., Wood, P. J., Hett, D. A., & Ohri, S. K. (2004). A prospective randomized study to evaluate stress response during beating-heart and conventional coronary revascularization. The Annals of Thoracic Surgery, 78(2), 506-12; discussion 506-12.
Velissaris T, et al. A Prospective Randomized Study to Evaluate Stress Response During Beating-heart and Conventional Coronary Revascularization. Ann Thorac Surg. 2004;78(2):506-12; discussion 506-12. PubMed PMID: 15276508.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A prospective randomized study to evaluate stress response during beating-heart and conventional coronary revascularization. AU - Velissaris,Theodore, AU - Tang,Augustine T M, AU - Murray,Matthew, AU - Mehta,Rajnikant L, AU - Wood,Peter J, AU - Hett,David A, AU - Ohri,Sunil K, PY - 2003/07/17/accepted PY - 2004/7/28/pubmed PY - 2005/5/25/medline PY - 2004/7/28/entrez SP - 506-12; discussion 506-12 JF - The Annals of thoracic surgery JO - Ann Thorac Surg VL - 78 IS - 2 N2 - 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 degrees 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. SN - 1552-6259 UR - https://www.unboundmedicine.com/medline/citation/15276508/A_prospective_randomized_study_to_evaluate_stress_response_during_beating_heart_and_conventional_coronary_revascularization_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0003497503013602 DB - PRIME DP - Unbound Medicine ER -