Improvement of outcomes after coronary artery bypass: A randomized trial comparing intraoperative high versus low mean arterial pressure

Jeffrey P. Gold, Mary E. Charlson, Pamela Williams-Russo, Ted P. Szatrowski, Janey C. Peterson, Paul A. Pirraglia, Gregg S. Hartman, Fun Sun F. Yao, James P. Hollenberg, Denise Barbut, Joseph G. Hayes, Stephen J. Thomas, Mary Helen Purcell, Steven Mattis, Larry Gorkin, Martin Post, Karl H. Krieger, O. Wayne Isom

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303 Scopus citations

Abstract

Background The objective of this randomized clinical trial of elective coronary artery bypass grafting was to investigate whether intraoperative mean arterial pressure below autoregulatory limits of the coronary and cerebral circulations was a principal determinant of postoperative complications. The trial compared the impact of two strategies of hemodynamic management during cardiopulmonary bypass on outcome. Patients were randomized to a low mean arterial pressure of 50 to 60 mm Hg or a high mean arterial pressure of 80 to 100 mm Hg during cardiopulmonary bypass. Methods A total of 248 patients undergoing primary, nonemergency coronary bypass were randomized to either low (n = 124) or high (n = 124) mean arterial pressure during cardiopulmonary bypass. The impact of the mean arterial pressure strategies on the following outcomes was assessed: mortality, cardiac morbidity, neurologic morbidity, cognitive deterioration, and changes in quality of life. All patients were observed prospectively to 6 months after the operation. Results The overall incidence of combined cardiac and neurologic complications was significantly lower in the high pressure group at 4.8% than in the low pressure group at 12.9% (p = 0.026). For each of the individual outcomes, the trend favored the high pressure group. At 6 months after coronary bypass for the high and low pressure groups, respectively, total mortality rate was 1.6% versus 4.0%, stroke rate 2.4% versus 7.2%, and cardiac complication rate 2.4% versus 4.8%. Cognitive and functional status outcomes did not differ between the groups. Conclusion Higher mean arterial pressures during cardiopulmonary bypass can be achieved in a technically safe manner and effectively improve outcomes after coronary bypass. (J THORAC CARDIOVASC SURG 1995;110:1302-14).

Original languageEnglish (US)
Pages (from-to)1302-1314
Number of pages13
JournalThe Journal of Thoracic and Cardiovascular Surgery
Volume110
Issue number5
DOIs
StatePublished - Nov 1995

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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    Gold, J. P., Charlson, M. E., Williams-Russo, P., Szatrowski, T. P., Peterson, J. C., Pirraglia, P. A., Hartman, G. S., Yao, F. S. F., Hollenberg, J. P., Barbut, D., Hayes, J. G., Thomas, S. J., Purcell, M. H., Mattis, S., Gorkin, L., Post, M., Krieger, K. H., & Isom, O. W. (1995). Improvement of outcomes after coronary artery bypass: A randomized trial comparing intraoperative high versus low mean arterial pressure. The Journal of Thoracic and Cardiovascular Surgery, 110(5), 1302-1314. https://doi.org/10.1016/S0022-5223(95)70053-6