Optimizing Haemodynamics in Off Pump Coronary Artery Bypass Grafting: The Impact of Prophylactic Vasopressin Administration

Tanveer Ahmed Khan; Muhammad Adnan Akram; Syed Aqeel Hussain; Umer Khan; Kaleem Ahmed; Syed Jawad Rehmani

doi:10.51253/pafmj.v76iSUPPL-8.13863

Authors

Tanveer Ahmed Khan Department of Cardiac Anaesthesia, Armed Forces Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Muhammad Adnan Akram Department of Cardiac Anaesthesia, Armed Forces Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Syed Aqeel Hussain Department of Cardiac Anaesthesia, Armed Forces Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Umer Khan Department of Cardiac Anaesthesia, Armed Forces Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Kaleem Ahmed Department of Cardiac Anaesthesia, Armed Forces Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Syed Jawad Rehmani Department of Cardiac Anaesthesia, Armed Forces Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan

DOI:

https://doi.org/10.51253/pafmj.v76iSUPPL-8.13863

Keywords:

Anaesthesia; Coronary Artery Bypass, Off-Pump; Intraoperative Care; Vasoconstrictor Agents; Vasopressin

Abstract

Objective: To evaluate the haemodynamic effects of prophylactic low-dose vasopressin in patients undergoing off-pump coronary artery bypass grafting (OPCAB).

Study Design: Quasi-experimental study.

Place and Duration of Study: Department of Cardiac Anaesthesia, Armed Forces Institute of Cardiology/National Institute of Heart Diseases (AFIC/NIHD) Rawalpindi, Pakistan from Oct 2024 to Mar 2025.

Methodology: Seventy-six male and female patients, aged between 30 and 70 years, who were scheduled for elective OPCAB were included. Patients were divided into two groups of 38 patients. Group-A received Vasopressin (0.03 IU/min) and Group-B (control group) received Normal Saline, initiated during left internal mammary artery (LIMA) harvesting and continued until the end of surgery. Haemodynamic parameters i.e. mean arterial pressure (MAP), heart rate (HR), and central venous pressure (CVP) were recorded at key surgical stages. Lactate, creatinine, and CK-MB levels were measured at baseline, and 6 hours and 24 hours postoperatively.

Results: The overall cohort comprised 59.2% males with a mean age of 55.6±8.1 years. During grafting, the Group-A maintained a higher MAP compared with Group-B (p≤0.05) and a lower mean HR (p≤0.05). No significant differences were observed in CVP or postoperative biochemical markers. Postoperative complications occurred in 21.05% of the Group-A and 28.95% of Group-B, a difference that was not statistically significant (p>0.05).

Conclusion: Low-dose vasopressin improves intraoperative haemodynamic stability in OPCAB without adverse effects.

Downloads

Download data is not yet available.

References

1. Vervoort D, Lee G, Ghandour H, Guetter CR, Adreak N, Till BM, et al. Global cardiac surgical volume and gaps: trends, targets, and way forward. Ann Thorac Surg Short Rep 2024; 14(5): 651-660. https://doi.org/10.1016/j.atssr.2023.11.019

2. Hossain N, Zaman S, Sadiq M, Jalal A, Abbas Q, Hashmi M, et al. The status of cardiac surgery in the South Asian countries around India. J Thorac Cardiovasc Surg 2020; 159(6): 2113-2119.

https://doi.org/10.1016/j.jtcvs.2019.08.100

3. Kilpatrick T, Dryden L. Anaesthesia for off-pump coronary artery bypass grafting. Anaesth Intensive Care Med 2024; 25(4): 244-248. https://doi.org/10.1016/j.mpaic.2024.01.004

4. He L, Tiemuerniyazi X, Chen L, Yang Z, Huang S, Nan Y, et al. Clinical outcomes of on-pump versus off-pump coronary artery bypass surgery: A meta-analysis. Int J Surg 2024; 110(8): 5063-5070. https://doi.org/10.1097/JS9.0000000000001481

5. Guarracino F, Habicher M, Treskatsch S, Sander M, Szekely A, Paternoster G, et al. Vasopressor Therapy in Cardiac Surgery: An experts’ consensus statement. J Cardiothorac Vasc Anesth 2021; 35(4): 1018–1029.

https://doi.org/10.1053/j.jvca.2020.11.032

6. Datt V, Wadhhwa R, Sharma V, Virmani S, Minhas HS, Malik S. Vasoplegic syndrome after cardiovascular surgery: A review of pathophysiology and outcome‐oriented therapeutic management. J Card Surg 2021; 36(10): 3749–3760.

https://doi.org/10.1111/jocs.15805

7. Heybati K, Xie G, Ellythy L, Poudel K, Deng J, Zhou F, et al. Outcomes of vasopressin-receptor agonists versus norepinephrine in adults with perioperative hypotension: a systematic review. J Cardiothorac Vasc Anesth 2024; 38(7): 1577-1586. https://doi.org/10.1053/j.jvca.2024.03.014

8. Jahangirifard A, Eraghi MG, Fani K, Tafrishinejad A, Dadashpour N, Ahmadi ZH, et al. Effect of Prophylactic Vasopressin on Haemodynamics Parameters after Coronary Artery Bypass Graft Surgery. J Cell Mol Anesth 2017; 2(3): e149535. https://doi.org/10.22037/jcma.v2i3.15315

9. Verma I, Beelwal P, Verma C, Vyas C. Haemodynamics Effects of Prophylactic Administration of Vasopressin in Patients Undergoing Off Pump Coronary Artery Bypass Graft Surgery: A Randomized Control Double Blind Interventional Study. Arch Anesth Crit Care 2022; 8 (Suppl 1): 377-382.

https://aacc.tums.ac.ir/index.php/aacc/article/view/494

10. Sullivan KM, Dean AG, Mir RA. OpenEpi - toolkit shell for developing new applications. Openepi.com 2013 [cited 2025 Jul 10]. https://www.openepi.com/SampleSize/SSMean.htm

11. Kato H, Mathis BJ, Shimoda T, Nakajima T, Tokunaga C, Hiramatsu Y. Haemodynamics management with vasopressin for cardiovascular surgery. Medicina 2024; 60(12): 2064.

https://doi.org/10.3390/medicina60122064

12. Couture P, Denault A, Limoges P, Sheridan P, Babin D, Cartier R. Mechanisms of haemodynamics changes during off-pump coronary artery bypass surgery. Can J Anaesth 2002; 49(8): 835–849. https://doi.org/10.1007/BF03017418

13. Shim J-K, Kim K-S, Couture P, Denault A, Kwak Y-L, Yoo K-J, et al. Haemodynamics management during off-pump coronary artery bypass surgery: a narrative review of proper targets for safe execution and troubleshooting. Korean J Anesthesiol 2023; 76(4): 267–279. https://doi.org/10.4097/kja.23103

14. Yimin H, Xiaoyu L, Yuping H, Weiyan L, Ning L. The effect of vasopressin on the haemodynamicss in CABG patients. J Cardiothorac Surg 2013; 8(1): 49.

https://doi.org/10.1186/1749-8090-8-49

15. Jeon Y, Ryu JH, Lim YJ, Kim CS, Bahk J-H, Yoon SZ, et al. Comparative haemodynamics effects of vasopressin and norepinephrine after milrinone-induced hypotension in off-pump coronary artery bypass surgical patients. Eur J Cardiothorac Surg 2006; 29(6): 952–956.

https://doi.org/10.1016/j.ejcts.2006.02.032

16. Hasija S, Makhija N, Choudhury M, Hote M, Chauhan S, Kiran U. Prophylactic vasopressin in patients receiving the angiotensin-converting enzyme inhibitor ramipril undergoing coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth 2010; 24(2): 230–238.

https://doi.org/10.1053/j.jvca.2009.08.001

17. Pandit SC, Kundalwal KA, Nikhate SD, Bhangare NK. Comparison of Vasopressin and Nor-Adrenaline for Haemodynamics Effects during Beating Heart Bypass Surgery. Indian J Basic Appl Med Res 2018; 7(4).

18. Papadopoulos G, Sintou E, Siminelakis S, Koletsis E, Baikoussis NG, Apostolakis E. Perioperative infusion of low- dose of vasopressin for prevention and management of vasodilatory vasoplegic syndrome in patients undergoing coronary artery bypass grafting-A double-blind randomized study. J Cardiothorac Surg 2010; 5(1): 17.

https://doi.org/10.1186/1749-8090-5-17

19. Yamane K, Fujii T, Aoyama T, Nonogaki M, Nishiwaki K. Impact of vasopressin use for postoperative atrial fibrillation in off-pump coronary artery bypass grafting. Nagoya J Med Sci 2024; 86(4): 645–654. https://doi.org/10.18999/nagjms.86.4.645