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Eur J Cardiothorac Surg 2004;25:320-326
© 2004 Elsevier Science NL

Impairment of cardiovascular autonomic control in patients early after cardiac surgery

^a Clinic for Cardiovascular Surgery, German Heart Center Munich, Lazarettstr. 36, D-80636 Munich, Germany
^b Forschungszentrum Karlsruhe GmbH, Institute for Applied Informatics, Postfach 3640, D-76021 Karlsruhe, Germany
^c Institute for Nonlinear Dynamics, University of Potsdam, Am Neuen Palais 10, D-14415 Potsdam, Germany

Received 21 October 2003; received in revised form 10 December 2003; accepted 15 December 2003.

^* Corresponding author. Tel.: +49-89-1218-4061; fax: +49-89-1218-4193
e-mail: bauernschmitt{at}dhm.mhn.de

Objective: Impairment of the baroreceptor reflex activity reflects an alteration of the autonomous regulation of the cardiovascular system and has proven to predict fatal outcome in patients after acute myocardial infarction. The following study was performed to analyse the baroreceptor sensitivity, heart rate variability and blood pressure variability in patients early after coronary surgery. Methods: Twenty-five male patients undergoing coronary artery bypass were examined in a prospective study; normal values were obtained from healthy volunteers. Arterial pressure signals were recorded from a radial artery catheter for 30 min preoperatively and in short intervals after surgery. Mechanical manipulations and pharmacological interventions were avoided during the sampling periods. Baroreflex function was calculated according to the dual sequence method, heart rate variability and blood pressure variability were calculated including nonlinear methods. Results: Initial values of the patients did not differ from healthy volunteers. The strength of baroreflex sensitivity (increase in blood pressure causing a synchronous decrease of heart rate) is low 2 h postoperatively. The number of delayed tachycardic changes of heart rate, which are caused by sympathetic activation, is only moderately reduced as compared to values obtained from healthy volunteers. Heart rate variability is widely unchanged as compared to preoperative values; blood pressure variability showed an increase of low-frequency components, again indicating sympathetic predominance. Nonlinear analyses revealed reduced system complexity at the beginning of the postoperative course. Conclusion: Obviously, there is a vagal suppression 20 h after surgery, while the sympathetic tonus works in a normal range. This unbalanced interaction of the autonomous systems is similar to findings in patients after myocardial infarction. The predictive value of these markers has to be elucidated in further clinical studies.

Key Words: Coronary surgery • Autonomic control • Heart rate variability • Nonlinear dynamics

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