판막수술을 시행 받는 환자에서 레닌-안지오텐신계 길항제가 체외순환 후 요골-대퇴동맥압 간의 차이에 미치는 영향

Abstract

Background Femoral to radial arterial pressure gradient (ΔP) often develops after cardiopulmonary bypass (CPB) where radial artery pressure (RAP) does not reflect the actual perfusion pressure. Renin-angiotensin system antagonists (RAS-A) are increasingly prescribed preoperatively which causes vasodilation and vascular remodeling. We evaluated the effect of RAS-A medication on ΔP after CPB in patients undergoing valvular heart surgery.

Methods Eighty-five patients scheduled for elective valvular heart surgery for regurgitant lesions were divided into two groups: the RAS-A group, in which patients were on RAS-A preoperatively (n = 52) and the control group (n = 33). Hemodynamic variables including RAP, femoral arterial pressure (FAP), body temperature, and hematocrit were recorded at after induction of anesthesia, pre-and post-CPB and sternum closure.

Results After CPB, systolic ΔP was significantly greater in the RAS-A group than in the control group. Nine (27%) and 36 (69%) patients after CPB, and 6 (18%) and 23 (44%) patients after sternum closure developed systolic ΔP more than 10 mmHg, in the control and RAS-A group, respectively, which were statistically significant. Body temperature, hematocrit and systemic vascular resistance index were not different between groups.

Conclusions Preoperative treatment with RAS-A resulted in clinically significant ΔP after cardiopulmonary bypass in about 70% of patients undergoing valvular heart surgery. Concomitant monitoring of FAP with RAP might be helpful to prevent inadequate vasopressor therapy guided by inaccurate RAP after CPB in this subset of patients.