Baroreflex sensitivity and outcomes following coronary surgery

Research output: Contribution to journalArticle

Abstract

Postoperative atrial fibrillation, acute kidney dysfunction and low cardiac output following coronary surgery are associated with morbidity and mortality. The purpose of this study is to determine if the preoperative autonomic control is a determinant of these postoperative complications. This is a prospective cohort study on 150 adult patients undergoing surgical coronary revascularization with cardiopulmonary bypass. The patients received an autonomic control assessment after the induction of anesthesia. Baroreflex sensitivity was computed by spectral analysis and expressed as BRSαHF and BRSαLF for measure respectively in the high and low frequency domains. Atrial fibrillation was adjudicated at any postoperative time during the hospital stay. Acute kidney dysfunction was defined as any increase of serum creatinine levels from preoperative values within the first 48 hours after surgery, and acute kidney injury was adjudicated at a 50% increase. Low cardiac ouput syndrome was defined as the need for inotropic support > 48 hours. Thirty-eight (26.4%) patients experienced postoperative atrial fibrillation; 32 (22.2%) had acute kidney dysfunction and 5 (3.5%) acute kidney injury; 14(10%) had a low cardiac output state. No indices of baroreflex sensitivity were associated with atrial fibrillation or acute kidney injury. A low value of BRSαLF was associated with acute kidney dysfunction and low cardiac output state. A BRSαLF <3 msec/mmHg was an independent risk factor for acute kidney dysfunction (odds ratio 3.0, 95% confidence interval 1.02-8.8, P = 0.045) and of low cardiac output state (odds ratio 17.0, 95% confidence interval 2.9-99, P = 0.002). Preoperative baroreflex sensitivity is linked to postoperative complications through a number of possible mechanisms, including an autonomic nervous system-mediated vasoconstriction, a poor response to hypotension, and an increased inflammatory reaction. © 2017 Ranucci et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Original languageEnglish
JournalPLoS One
Volume12
Issue number4
DOIs
Publication statusPublished - 2017

Keywords

  • amiodarone
  • beta adrenergic receptor blocking agent
  • calcium antagonist
  • creatinine
  • dipeptidyl carboxypeptidase inhibitor
  • inotropic agent
  • acute disease
  • acute kidney failure
  • adult
  • aged
  • anesthesia induction
  • Article
  • atrial fibrillation
  • autonomic nervous system function
  • blood vessel reactivity
  • cardiopulmonary bypass
  • clinical outcome
  • cohort analysis
  • controlled study
  • coronary artery disease
  • coronary artery surgery
  • creatinine blood level
  • female
  • heart disease
  • heart muscle revascularization
  • hospitalization
  • human
  • hypertension
  • hypotension
  • inflammation
  • kidney dysfunction
  • low cardiac ouput syndrome
  • major clinical study
  • male
  • postoperative complication
  • postoperative period
  • preoperative evaluation
  • pressoreceptor reflex
  • pressure measurement
  • prospective study
  • risk assessment
  • risk factor
  • syndrome
  • treatment response
  • vasoconstriction
  • adverse effects
  • middle aged
  • Aged
  • Baroreflex
  • Cardiopulmonary Bypass
  • Female
  • Humans
  • Male
  • Middle Aged
  • Prospective Studies

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