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Improvement of Outcomes after Coronary Artery Bypass II: A Randomized Trial Comparing Intraoperative High Versus Customized Mean Arterial Pressure
Author(s) -
Charlson Mary E.,
Peterson Janey C.,
Krieger Karl H.,
Hartman Gregg S.,
Hollenberg James P.,
Briggs William M.,
Segal Alan Z.,
Parikh Manish,
Thomas Stephen J.,
Donahue Rebecca G.,
Purcell Mary Helen,
Pirraglia Paul A.,
Isom O. Wayne
Publication year - 2007
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/j.1540-8191.2007.00471.x
Subject(s) - medicine , randomized controlled trial , mean arterial pressure , cardiopulmonary bypass , coronary artery bypass surgery , artery , randomization , blood pressure , myocardial infarction , surgery , anesthesia , cardiology , heart rate
Background and Aim of the Study: The objective of this randomized trial was to compare the efficacy of two strategies of hemodynamic management during cardiopulmonary bypass (CPB) on morbidity, mortality, cognitive complications and deterioration in functional status. Methods: Patients scheduled to undergo primary elective CABG were eligible. In one group, mean arterial pressure target during CPB was 80 mmHg (“high” MAP group); in the other group, MAP target was determined by patients’ pre‐bypass MAP (“custom” MAP group). The principal outcomes were mortality, major neurologic or cardiac complications, cognitive complications or deterioration in functional status. Results: Of 412 enrolled patients, 36% were women, with overall mean age of 64.7 ± 12.3 years. Duration of bypass was identical for the two randomization groups. Overall complication rates were similar: 16.5% of the high group and 14.6% of the custom group experienced one or more neurologic, cardiac or cognitive complications. When only cardiac and neurologic morbidity and mortality were considered, the rates were 11.7% and 12.6%, in the high and custom groups, respectively. The aggregate outcome rate, including functional deterioration, was 31.6% in the high group and 29.6% in the custom group. Conclusions: There were no statistically significant differences between the high MAP group and the custom MAP group for the combined outcome of mortality cardiac, neurologic or cognitive complications, and deterioration in the quality of life.