Effects of pulsatile cardiopulmonary bypass on the renin-angiotensin-aldosterone system following open heart surgery |
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Authors: | Hideo Nagaoka MD Ryuichi Innami Hirokuni Arai |
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Institution: | (1) Department of Cardiovascular Surgery, Tsuchiura Kyodo General Hospital, 11-7, Manabe-shinmachi, 500 Tsuchiura, Ibaraki, Japan |
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Abstract: | The effects of pulsatile cardiopulmonary bypass on the renin-angiotensin-aldosterone system and tissue metabolism, especially
those which occur soon after surgery, were studied in 26 patients who required total cardiopulmonary bypass for longer than
60 minutes. These patients comprised 11 who underwent open heart surgery utilizing nonpulsatile cardiopulmonary bypass (Group
I) and 15 who underwent open heart surgery utilizing pulsatile cardiopulmonary bypass (Group II). Plasma angiotensin II and
serum aldosterene levels were significantly increased one and 5 hours postoperatively in Group I when compared with the preoperative
values, whereas no significant elevations were observed in Group II. Plasma angiotensin II and serum aldosterone levels one
hour postoperatively in Group II were significantly lower than those in Group I. Lactate levels in the arterial blood were
significantly elevated, one and 5 hours postoperatively in both Groups I and II. Moreover, no significant difference was observed
in the lactate levels between Groups I and II, one hour postoperatively. In the nonpulsatile group (Group I), plasma angiotensin
II levels one hour postoperatively were correlated significantly with the duration of total cardiopulmonary bypass. In conclusion,
pulsatile cardiopulmonary bypass offers significant advantages in terms of lower plasma angiotensin II and serum aldosterone
levels, when compared with nonpulsatile cardiopulmonary bypass soon after open heart surgery requiring total cardiopulmonary
bypass for longer than 60 minutes, however, it does not offer a definite advantage for tissue metabolism. |
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Keywords: | pulsatile cardiopulmonary bypass renin-angiotensin-aldosterone system lactate |
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