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Ann Thorac Surg 1979;28:261-268
© 1979 The Society of Thoracic Surgeons
From the Maritime Heart Center, and the Division of Cardiovascular Surgery, Department of Anesthesia, and Division of Clinical Chemistry, Dalhousie University, Halifax, NS, Canada.
* Address reprint requests to Dr. Murphy, 5850 University Ave, Halifax, NS, Canada B3J 3G9.
Twenty patients undergoing primary elective aorta–coronary artery bypass were divided into two equal groups, both receiving identical premedication, anesthetic, and pump primes. The control patients received hypothermic nonpulsatile flow and the study patients received hypothermic pulsatile flow.
Hypertension, defined as a pressure of 160/100 mm Hg or higher, was observed in 80% of the control patients and 20% of the patients receiving pulsatile flow (p < 0.05). Serial renin measurements demonstrated maximum values in the intensive care unit and coincided with the onset of postoperative hypertension in the control patients. Those patients who had received pulsatile flow did not demonstrate notable renin stimulation. Catecholamines were markedly elevated during bypass and in the intensive care unit, but there was no significant difference between the two groups. Peripheral vascular resistance was not significantly lower with pulsatile flow, except in the first study performed in the intensive care unit.
We conclude that catecholamines and the renin-angiotensin system contribute to the production of postoperative hypertension and that pulsatile flow diminishes renin stimulation. Pulsatile flow results in a decreased incidence of postoperative hypertension.
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