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Improvement of outcomes after coronary artery bypass II: a randomized trial comparing intraoperative high versus customized mean arterial pressure.

TitleImprovement of outcomes after coronary artery bypass II: a randomized trial comparing intraoperative high versus customized mean arterial pressure.
Publication TypeJournal Article
Year of Publication2007
AuthorsCharlson ME, Peterson JC, Krieger KH, Hartman GS, Hollenberg JP, Briggs WM, Segal AZ, Parikh M, Thomas SJ, Donahue RG, Purcell MHelen, Pirraglia PA, O Isom W
JournalJ Card Surg
Date Published2007 Nov-Dec
KeywordsAged, Blood Pressure, Cardiopulmonary Bypass, Cognition, Cognition Disorders, Coronary Artery Bypass, Coronary Artery Disease, Female, Humans, Male, Middle Aged, Nervous System Diseases, Postoperative Complications, Postoperative Period, Risk Factors, Time Factors, Treatment Outcome

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.

Alternate JournalJ Card Surg
PubMed ID18039205
Grant ListHL44719 / HL / NHLBI NIH HHS / United States