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Baroreflex sensitivity and outcomes following coronary surgery
Marco Ranucci1, Alberto Porta1,2, Vlasta Bari1
1Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy.
Plos One
|April 7, 2017
Summary
Preoperative baroreflex sensitivity, a measure of autonomic control, is linked to cardiac surgery complications. Low baroreflex sensitivity predicts acute kidney dysfunction and low cardiac output, impacting patient outcomes.
Area of Science:
- Cardiology
- Nephrology
- Anesthesiology
Background:
- Postoperative atrial fibrillation, acute kidney dysfunction, and low cardiac output syndrome are significant complications following coronary artery bypass grafting (CABG).
- These complications are associated with increased morbidity and mortality in cardiac surgery patients.
- The role of preoperative autonomic nervous system (ANS) function in predicting these adverse outcomes remains incompletely understood.
Purpose of the Study:
- To investigate whether preoperative autonomic control, specifically baroreflex sensitivity (BRS), is a determinant of major postoperative complications after coronary surgery.
- To identify if impaired BRS predicts the occurrence of atrial fibrillation, acute kidney dysfunction, or low cardiac output syndrome.
Main Methods:
- A prospective cohort study involving 150 adult patients undergoing coronary revascularization with cardiopulmonary bypass.
- Autonomic control was assessed preoperatively using spectral analysis of baroreflex sensitivity, yielding BRSαHF and BRSαLF values.
- Postoperative outcomes including atrial fibrillation, acute kidney dysfunction (defined by serum creatinine changes), and low cardiac output syndrome were meticulously monitored.
Main Results:
- No significant association was found between baroreflex sensitivity indices and postoperative atrial fibrillation or acute kidney injury.
- A low BRSαLF (low frequency domain) was significantly associated with an increased incidence of acute kidney dysfunction and low cardiac output state.
- Specifically, a BRSαLF < 3 msec/mmHg independently predicted acute kidney dysfunction (OR 3.0) and low cardiac output state (OR 17.0).
Conclusions:
- Preoperative baroreflex sensitivity, particularly in the low-frequency domain (BRSαLF), is a valuable predictor of acute kidney dysfunction and low cardiac output syndrome after CABG.
- These findings suggest that impaired autonomic regulation may contribute to adverse postoperative outcomes through mechanisms like exaggerated vasoconstriction and inflammatory responses.
- Assessment of preoperative BRS may aid in identifying high-risk patients for targeted interventions to mitigate postoperative complications.