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Perioperative indicators of stress response and postoperative inflammatory complications in patients undergoing off-pump coronary artery bypass surgery: a prospective observational study

Authors
 Suk-Won Song  ;  Gijong Yi  ;  Sak Lee  ;  Young-Nam Youn  ;  Soon-Young Sul  ;  Kyung-Jong Yoo 
Citation
 CIRCULATION JOURNAL, Vol.72(12) : 1966-1974, 2008 
Journal Title
 CIRCULATION JOURNAL 
ISSN
 1346-9843 
Issue Date
2008
MeSH
Adult ; Aged ; Aged, 80 and over ; Atrial Fibrillation/blood ; Atrial Fibrillation/etiology ; Atrial Fibrillation/physiopathology ; Biomarkers/blood ; Blood Coagulation ; Blood Sedimentation ; C-Reactive Protein/metabolism ; Coronary Artery Bypass, Off-Pump/adverse effects* ; Coronary Artery Disease/blood ; Coronary Artery Disease/immunology ; Coronary Artery Disease/physiopathology ; Coronary Artery Disease/surgery* ; Female ; Fibrin Fibrinogen Degradation Products/metabolism ; Hemodynamics ; Humans ; Hydrocortisone/blood* ; Inflammation Mediators/blood ; Leukocyte Count ; Lung Diseases/blood ; Lung Diseases/etiology ; Lung Diseases/physiopathology ; Male ; Middle Aged ; Platelet Count ; Preoperative Care ; Prospective Studies ; Stress, Physiological* ; Surgical Wound Infection/blood ; Surgical Wound Infection/etiology ; Surgical Wound Infection/physiopathology ; Systemic Inflammatory Response Syndrome/blood ; Systemic Inflammatory Response Syndrome/etiology* ; Systemic Inflammatory Response Syndrome/immunology ; Systemic Inflammatory Response Syndrome/physiopathology ; Time Factors
Keywords
Cortisol ; Off-pump coronary artery bypass surgery
Abstract
BACKGROUND: Little has been published regarding the association between perioperative stress response and clinical outcomes after off-pump coronary artery bypass surgery (OPCAB). The role of perioperative stress response in postoperative inflammatory complications (PIC) in patients undergoing OPCAB was assessed. METHODS AND RESULTS: The study cohort consisted of 100 patients who underwent elective OPCAB over a 5-month period. Anesthetic management was standardized and blood samples were collected before surgery, immediately after surgery, and 1, 2, 3, and 7 days after surgery. Leukocyte, neutrophil, platelet, erythrocyte sedimentation rate, C-reactive protein, fibrinogen, cortisol, D-dimer, and fibrin degradation product were measured at each time point, and the association of each parameter with PIC was assessed. PIC included postoperative pulmonary complications, atrial fibrillation, and wound infections. PIC occurred in 30 patients at the median third postoperative day. Multivariate analysis showed preoperative cortisol (p=0.024) and cortisol on the first postoperative day (p=0.001) were significantly associated with PIC. Intraoperative cortisol release was correlated with intraoperative hemodynamic changes, including pulmonary artery pressure, central venous pressure, and cardiac index. CONCLUSIONS: Patients with PIC after OPCAB have significantly increased preoperative cortisol and cortisol on the first postoperative day. Intraoperative cortisol release was significantly correlated with hemodynamic changes. The neurohormonal environment and inflammatory response during and after beating-heart surgery should be further explored.
Files in This Item:
T200801450.pdf Download
DOI
10.1253/circj.CJ-08-0291
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
Yonsei Authors
Song, Suk Won(송석원) ORCID logo https://orcid.org/0000-0002-9850-9707
Yoo, Kyung Jong(유경종) ORCID logo https://orcid.org/0000-0002-9858-140X
Youn, Young Nam(윤영남)
Yi, Gi Jong(이기종)
Lee, Sak(이삭) ORCID logo https://orcid.org/0000-0001-6130-2342
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/107757
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