The Effects of On-Pump and Off-Pump Coronary Artery Bypass Surgery on Metabolic Profiles in the Early Postoperative Period

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• 作者：Filippo Sanfilippo ; MD ; PhD ; EDIC^* ; ^&dagger ; ; ^{filipposanfi@yahoo.it" class="auth_mail" title="E-mail the corresponding author} ; Federica Chiarenza ; MD^* ; ^&dagger ; ; Cesare Cassisi ; MD^* ; ^&dagger ; ; Cristina Santonocito ; MD^* ; ^&dagger ; ; Theodoros Tsoutsouras ; MD^* ; Marialena Trivella ; BSc ; MSc ; PhD^&Dagger ; ; Stephen Gerry ; BSc ; MSc^&Dagger ; ; Marinella Astuto ; MD^&dagger ; ; Shane George ; MD ; MBA^* ; David P. Taggart ; MD ; PhD ; FRCS^* ; ^§ ;
• 关键词：acidosis ; cardiac surgery ; intensive care ; lactates ; base excess
• 刊名：Journal of Cardiothoracic and Vascular Anesthesia
• 出版年：2016
• 出版时间：August 2016
• 年：2016
• 卷：30
• 期：4
• 页码：909-916
• 全文大小：444 K

文摘

Hyperlactatemia and base deficit (BD) are markers of adverse outcome after cardiac surgery, and their derangement can be influenced by the use of extracorporeal circulation. The authors hypothesized a better postoperative metabolic profile in off-pump coronary artery bypass grafting (OPCABG) compared with “on-pump” coronary artery bypass grafting (ONCABG).

Design

This was a retrospective study, with consecutive data collected for 1 year from electronic medical records.

Setting

Cardiothoracic intensive care unit at a tertiary university hospital.

Participants

The study comprised 339 patients who underwent elective coronary artery bypass grafting (ONCABG [n = 215], OPCABG [n = 124]).

Interventions

None.

Measurements and Main Results

The metabolic (arterial lactatemia, pH, and BD) and hemodynamic (inotropic/vasopressor support) parameters of OPCABG and ONCABG patients were compared at 7 predefined time points (intensive care admission and the 1st, 3rd, 6th, 12th, 18th, and 24th postoperative hours). For each output of interest, mixed-effects linear regression models were used (with time as random-effect to allow for clustering of repeated measures) and adjusted for a predetermined set of covariates.

Arterial lactatemia and pH were comparable at all time points; BD was worse in the ONCABG group overall (p = 0.01) and at most time points (except at the 1st and 24th postoperative hours). For the whole period, inotropic support was more common in ONCABG patients (p<0.05), whereas vasopressor use was more frequent in the OPCABG group (p< 0.05).

Conclusions

Improved postoperative BD values were demonstrated in the OPCABG group, although pH and lactatemia were similar between groups. Inotropic support was less common in the OPCABG group at the expense of more frequent vasopressor support.