Cardiopulmonary bypass increases the risk of vasoplegic syndrome after coronary artery bypass grafting in patients with dialysis-dependent chronic renal failure

Objective

Coronary artery bypass grafting is currently the best treatment for dialysispatients with multivessel coronary artery involvement. Vasoplegic syndromeof inflammatory etiology constitutes an important postoperativecomplication, with highly negative impact on prognosis. Considering thatthese patients have an intrinsic inflammatory response exacerbation, ourgoal was to evaluate the incidence and mortality of vasoplegic syndromeafter myocardial revascularization in this group.

Methods

A retrospective, single-center study of 50 consecutive and non-selecteddialysis patients who underwent myocardial revascularization in a tertiaryuniversity hospital, from 2007 to 2012. The patients were divided into 2groups, according to the use of cardiopulmonary bypass or not (off-pumpcoronary artery bypass). The incidence and mortality of vasoplegic syndromewere analyzed. The subgroup of vasoplegic patients was studiedseparately.

Results

There were no preoperative demographic differences between thecardiopulmonary bypass (n=20) and off-pump coronary artery bypass (n=30)group. Intraoperative data showed a greater number of distal coronaryarteries anastomosis (2.8 vs. 1.8,P<0.0001) and higher transfusion rates (65%vs. 23%, P=0.008) in thecardiopulmonary bypass group. Vasoplegia incidence was statistically higher(P=0.0124) in the cardiopulmonary bypass group (30%)compared to the off-pump coronary artery bypass group (3%). Vasoplegiamortality was 50% in the cardiopulmonary bypass group and 0% in the off-pumpcoronary artery bypass group. The vasoplegic subgroup analysis showed nostatistically significant clinical differences.

Conclusion

Cardiopulmonary bypass increased the risk for developing postoperativevasoplegic syndrome after coronary artery bypass grafting in patients withdialysis-dependent chronic renal failure.