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Ann Thorac Surg 2003;78:506-512
© 2003 The Society of Thoracic Surgeons
a Wessex Cardiothoracic Centre, Southampton, United Kingdom
b Department of Endocrinology, Southampton General Hospital, Southampton, United Kingdom
Accepted for publication July 17, 2003.
* Address reprint requests to Dr Velissaris, Wessex Cardiothoracic Centre, Southampton General Hospital, Tremona Rd, Southampton, SO16 6YD, UK.
e-mail: theo{at}velissaris.com
Presented at the Thirty-ninth Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Jan 31–Feb 2, 2003.
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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