Intraoperative vasopressor and inotropic support during coronary artery bypass grafting: preliminary results of AMIRI-CABG trial
Abstract
Aim – to define type of coronary artery bypass grafting associated with lower hemodynamic instability caused by intraoperative myocardial ischemic-reperfusion injury. To compare vasopressor and inotrope demand during coronary artery bypass grafting. To evaluate relation between intraoperative dose of vasopressor and inotrope agents during coronary artery bypass grafting.
Material and methods. We evaluated intraoperative hemodynamic instability caused by ischemic-reperfusion injury in non-randomized single center prospective trial of First Saint-Petersburg Pavlov University Assessment of myocardial ischemic-reperfusion injury during off- and on-pump coronary artery bypass grafting (AMIRI-CABG) (ClinicalTrials.gov Identifier: NCT03050489, 2016– 2019 years). There were off-pump coronary artery bypass grafting group (n=177 patients), on-pump coronary artery bypass grafting group (n=128 patients) and pump-assisted coronary artery bypass grafting (n=33 patients). Level of evidence II.
Results. Logistic regression shows significant influence of noradrenalin dosage on higher risk of death within postoperative 30-days period in off-pump coronary artery bypass grafting group (AUC=0.78). Adrenalin dosage and risk of death within postoperative 30-days period were found to be related in off-pump coronary artery bypass grafting group as well. Intraoperative noradrenalin and adrenalin dosage were not associated with risk of death within postoperative 30-days period in on-pump coronary artery bypass grafting group.
Conclusion. Intraoperative hemodynamic instability caused by heart displacement during off- pump coronary artery bypass grafting and myocardial ischemic-reperfusion injury is associated with higher noradrenalin demand and risk of death within postoperative 30-days period than during on-pump coronary artery bypass grafting. There is no relation between intraoperative noradrenalin and adrenalin demand in on-pump coronary artery bypass grafting group that could be associated with lower ischemic-reperfusion injury.
Keywords:coronary artery bypass grafting, off-pump coronary bypass grafting, on-pump coronary artery bypass grafting, ischemic- reperfusion injury, noradrenaline, adrenaline
Conflict of interest. The authors declare no conflict of interest.
For citation: Bunenkov N.S., Komok V.V., Molchan N.S., Nemkov A.S., Khubulava G.G. Intraoperative vasopressor and inotropic support during coronary artery bypass grafting: preliminary results of AMIRI-CABG trial. Clin Experiment Surg. Petrovsky J. 2020; 8 (2): 83–8. DOI: 10.33029/2308-1198-2020-8-2-83-88 (in Russian)
Received 05.11.2019. Accepted 26.03.2020.
References
1. Carvalho A.R., Guizilini S., Murai G.M., Begot I., Rocco I.S., Hossne N.A. Jr., et al. Hemodynamic Changes During Heart Displacement in Aorta No-Touch Off-Pump Coronary Artery Bypass Surgery: A Pilot Study. Braz J Cardiovasc Surg. 2018; 33 (5): 469–75.
2. Sedov V.M., Nemkov A.S. Vasilii Ivanovich Kole- sov: pioneer of coronary surgery. Eur J Cardiothorac Surg. 2014; 45 (2): 220–4.
3. Benedetto U., Altman D.G., Gerry S., Gray A., Lees B., Flather M., et al. Off-pump versus on-pump coronary artery bypass grafting: Insights from the Arterial Revascularization Trial. J Thorac Cardiovasc Surg. 2018; 155 (4): 1545–53.
4. Khubulava G.G., Avaliani V.M. Myocardial protection during coronary artery bypass grafting: current status of the problem. Kardiologiya i serdechno-sosudistaya khirurgiya [Russian Journal of Cardiology and Cardiovascular Surgery]. 2013; 5: 42–7. (in Russian)
5. Molchan N.S., Polushin Y.S., Zhloba A.A., Kobak A.E., Khryapa A.A. Is it possible to augment myocardial protection during cardiopulmonary bypass by administration of inhalational anesthetics? Al'manakh klinicheskoy meditsiny [Almanac of Clinical Medicine]. 2019; 47 (3): 221–7. DOI: https://doi.org/10.18786/2072- 0505-2019-47-036. (in Russian)
6. Gaudino M., Angelini G.D., Antoniades C., Bakaeen F., Benedetto U., Calafiore A.M., et al. Off-Pump Coronary Artery Bypass Grafting: 30 Years of Debate. J Am Heart Assoc. 2018; 7 (16): e009934.
7. Elci M.E., Kahraman A., Mutlu E., Ispir C.S. Effects of Minimal Extracorporeal Circulation on the Systemic Inflammatory Response and the Need for Transfusion after Coronary Bypass Grafting Surgery. Cardiol Res Pract. 2019; 2019: 1726150.
8. Lomivorotov V.V., Efremov S.M., Kirov M.Y., Fominskiy E.V., Karaskov A.M. Low-Cardiac-Output Syndrome After Cardiac Surgery. J Cardiothorac Vasc Anesth. 2017; 31 (1): 291–308.
9. Benedetto U., Lau C., Caputo M., Kim L., Feldman D.N., Ohmes L.B., et al. Comparison of Outcomes for Off-Pump Versus On-Pump Coronary Artery Bypass Grafting in Low-Volume and High-Volume Centers and by Low-Volume and High-Volume Surgeons. Am J Cardiol. 2018; 121 (5): 552–7.
10. Smart N.A., Dieberg G., King N. Long-Term Out- comes of On- Versus Off-Pump Coronary Artery Bypass Grafting. J Am Coll Cardiol. 2018; 71 (9): 983–91.
11. Hemmerling T.M., Romano G., Terrasini N., Noi- seux N. Anesthesia for off-pump coronary artery bypass surgery. Ann Card Anaesth. 2013; 16 (1): 28–39.