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Is incidence of postoperative vasoplegic syndrome different between off-pump and on-pump coronary artery bypass grafting surgery?

Section of Cardiac Surgery, Department of Surgery, Washington Hospital Center, 110 Irving Street, N.W., Suite 1E3, Washington, DC 20010-2975, United States

Received 12 February 2008; received in revised form 9 July 2008; accepted 14 July 2008.

^_* Corresponding author. Tel.: +1 202 877 0277; fax: +1 202 291 1436. (Email: xiumei.sun{at}medstar.net).

Objective: Postoperative vasoplegic syndrome (PVS) is a potentially lethal condition with increased mortality and other postoperative morbidities. Many previous studies have examined the outcomes associated with on-pump coronary artery bypass grafting (CABG) surgery, little is known about the incidence of PVS after off-pump CABG. Methods: From November 21, 2005 to June 9, 2006, 334 patients underwent isolated on-pump CABG and 362 had off-pump CABG surgery. Perioperative variables were retrospectively compared between on-pump and off-pump CABG surgery using univariate analysis. Significant variables were included into a stepwise regression model to ascertain their independent impact on the incidence of PVS. Results: The incidence of PVS in isolated on-pump CABG was 6.9%; in off-pump CABG was 2.8% (p = 0.01). However, in multivariable models adjusted for confounders, on-pump CABG did not reach statistical significance as a risk factor of PVS (OR = 2.3, 95% CI 0.94–5.78; p = 0.07). In on-pump CABG, preoperative left ventricular EF less than 35% (OR = 3.6; p = 0.02) and increased body mass index (OR = 1.1; p = 0.04) were identified as risk predictors of PVS; whereas elective surgery (OR = 0.2; p = 0.02) and preoperative use of β-blockers (OR = 0.21; p = 0.02) were associated with a decreased rate of PVS. PVS was associated with longer ICU stay (OR = 6.0; p < 0.01), postoperative ventilation (OR = 4.6; p < 0.01), and hospital stay (OR = 2.62; p = 0.03). There was a stronger association between preoperative ACE inhibitors therapy and increased risk of PVS in off-pump CABG surgery (OR = 4.52, 95% CI 0.95–21.67; p = 0.06) than in on-pump CABG surgery (OR = 1.06, 95% CI 0.35–3.19; p = 0.91), but neither of them reaches statistical significance. Conclusions: The incidence of PVS after off-pump CABG surgery was significantly lower than after on-pump CABG surgery.

Key Words: Postoperative vasoplegic syndrome • Off-pump • On-pump • Coronary artery bypass grafting

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