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Titolo:
IMPROVEMENT OF OUTCOMES AFTER CORONARY-ARTERY BYPASS - A RANDOMIZED TRIAL COMPARING INTRAOPERATIVE HIGH VERSUS LOW MEAN ARTERIAL-PRESSURE
Autore:
GOLD JP; CHARLSON ME; WILLIAMSRUSSO P; SZATROWSKI TP; PETERSON JC; PIRRAGLIA PA; HARTMAN GS; YAO FSF; HOLLENBERG JP; BARBUT D; HAYES JG; THOMAS SJ; PURCELL MH; MATTIS S; GORKIN L; POST M; KRIEGER KH; ISOM OW;
Indirizzi:
NEW YORK HOSP,CORNELL MED CTR,DEPT CARDIOTHORAC SURG,SUITE F2114,525 E 68TH ST NEW YORK NY 10021 CORNELL UNIV,COLL MED,CORNELL CORONARY ARTERY BYPASS OUTCOMES TRIAL GRP NEW YORK NY 00000 HOSP SPECIAL SURG NEW YORK NY 00000 LONG ISL JEWISH MED CTR,HILLSIDE HOSP,DEPT CARDIOTHORAC SURG GLEN OAKS NY 11004 LONG ISL JEWISH MED CTR,HILLSIDE HOSP,DEPT MED GLEN OAKS NY 11004 LONG ISL JEWISH MED CTR,HILLSIDE HOSP,DEPT ANESTHESIOL GLEN OAKS NY 11004 LONG ISL JEWISH MED CTR,HILLSIDE HOSP,DEPT NEUROL GLEN OAKS NY 11004 LONG ISL JEWISH MED CTR,HILLSIDE HOSP,DEPT PSYCHIAT GLEN OAKS NY 11004 DEGGE GRP LTD ALEXANDRIA VA 00000
Titolo Testata:
Journal of thoracic and cardiovascular surgery
fascicolo: 5, volume: 110, anno: 1995,
pagine: 1302 - 1314
SICI:
0022-5223(1995)110:5<1302:IOOACB>2.0.ZU;2-I
Fonte:
ISI
Lingua:
ENG
Soggetto:
CEREBRAL BLOOD-FLOW; CARDIOPULMONARY BYPASS; MYOCARDIAL-ISCHEMIA; GRAFT-SURGERY; NEUROPSYCHIATRIC COMPLICATIONS; SUFENTANIL ANESTHESIA; DYSFUNCTION; VALIDATION; MORBIDITY; RISK;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Science Citation Index Expanded
Science Citation Index Expanded
Citazioni:
37
Recensione:
Indirizzi per estratti:
Citazione:
J.P. Gold et al., "IMPROVEMENT OF OUTCOMES AFTER CORONARY-ARTERY BYPASS - A RANDOMIZED TRIAL COMPARING INTRAOPERATIVE HIGH VERSUS LOW MEAN ARTERIAL-PRESSURE", Journal of thoracic and cardiovascular surgery, 110(5), 1995, pp. 1302-1314

Abstract

Background The objective of this randomized clinical trial of elective coronary artery bypass grafting was to investigate whether intraoperative mean arterial pressure below autoregulatory limits of the coronary and cerebral circulations was a principal determinant of postoperative complications. The trial compared the impact of two strategies of hemodynamic management during cardiopulmonary bypass on outcome. Patients were randomized to a low mean arterial pressure of 50 to 60 mm Hg or a high mean arterial pressure of 80 to 100 mm Hg during cardiopulmonary bypass. Methods A total of 248 patients undergoing primary, nonemergency coronary bypass, were randomized to either low (n = 124) or high (n = 124) mean arterial pressure during cardiopulmonary: bypass. The impact of the mean arterial pressure strategies on the following outcomes was assessed: mortality, cardiac morbidity, neurologic morbidity, cognitive deterioration, and changes in quality of life. All patients were observed prospectively to 6 months after the operation. ResultsThe overall incidence of combined cardiac and neurologic complications was significantly lower in the high pressure group at 4.8% than in the low pressure group at 12.9% (p = 0.026). For each of the individualoutcomes, the trend favored the high pressure group. At 6 months after coronary bypass for the high and low pressure groups, respectively, total mortality rate was 1.6% versus 4.0%, stroke rate 2.4% versus 7.2%, and cardiac complication rate 2.4% versus 4.8%. Cognitive and functional status outcomes did not differ between the groups. Conclusion Higher mean arterial pressures during cardiopulmonary bypass can be achieved in a technically safe manner and effectively improve outcomes after coronary bypass.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 02/04/20 alle ore 00:02:49