TITLE

Is incidence of postoperative vasoplegic syndrome different between off-pump and on-pump coronary artery bypass grafting surgery?

AUTHOR(S)
Sun, Xiumei; Zhang, Li; Hill, Peter C.; Lowery, Robert; Lee, Anne T.; Molyneaux, Robert E.; Corso, Paul J.; Boyce, Steven W.
PUB. DATE
October 2008
SOURCE
European Journal of Cardio-Thoracic Surgery;Oct2008, Vol. 34 Issue 4, p820
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Abstract: Objective: Postoperative vasoplegic syndrome (PVS) is a potentially lethal condition with increased mortality and other postoperative morbidities. Many previous studies have examined the outcomes associated with on-pump coronary artery bypass grafting (CABG) surgery, little is known about the incidence of PVS after off-pump CABG. Methods: From November 21, 2005 to June 9, 2006, 334 patients underwent isolated on-pump CABG and 362 had off-pump CABG surgery. Perioperative variables were retrospectively compared between on-pump and off-pump CABG surgery using univariate analysis. Significant variables were included into a stepwise regression model to ascertain their independent impact on the incidence of PVS. Results: The incidence of PVS in isolated on-pump CABG was 6.9%; in off-pump CABG was 2.8% (p =0.01). However, in multivariable models adjusted for confounders, on-pump CABG did not reach statistical significance as a risk factor of PVS (OR=2.3, 95% CI 0.94–5.78; p =0.07). In on-pump CABG, preoperative left ventricular EF less than 35% (OR=3.6; p =0.02) and increased body mass index (OR=1.1; p =0.04) were identified as risk predictors of PVS; whereas elective surgery (OR=0.2; p =0.02) and preoperative use of β-blockers (OR=0.21; p =0.02) were associated with a decreased rate of PVS. PVS was associated with longer ICU stay (OR=6.0; p <0.01), postoperative ventilation (OR=4.6; p <0.01), and hospital stay (OR=2.62; p =0.03). There was a stronger association between preoperative ACE inhibitors therapy and increased risk of PVS in off-pump CABG surgery (OR=4.52, 95% CI 0.95–21.67; p =0.06) than in on-pump CABG surgery (OR=1.06, 95% CI 0.35–3.19; p =0.91), but neither of them reaches statistical significance. Conclusions: The incidence of PVS after off-pump CABG surgery was significantly lower than after on-pump CABG surgery.
ACCESSION #
34649565

 

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