title: Vasoplegic syndrome after off-pump coronary artery bypass surgery.
abstract: OBJECTIVE
  The vasoplegic syndrome (VS) has been implicated in life-threatening complications after open heart surgery, where the whole-body inflammatory reaction is attributed to the cardiopulmonary bypass (CPB). Off-pump coronary artery bypass grafting (OPCAB) has been recently achieving growing enthusiasm mainly due avoiding the side effects of CPB. However herein the occurrence of VS in OPCAB is reported.
  
  
  METHODS
  The vasoplegic syndrome usual findings occurring in the early postoperative period include severe hypotension, tachycardia, normal or elevated cardiac output and low systemic vascular resistance. Four patients underwent to OPCAB presented all the signs of VS intraoperatively or within the first 6 postoperative h.
  
  
  RESULTS
  The patients needed aggressive vasoactive drug support for hemodynamic stabilization and all of them developed complications. These patients also had tendency to require administration of blood and blood derivatives due to diffuse and oozing type bleeding. Mean intensive care unit stay of surviving patients was 70 h and mean period of postoperative hospitalization was 9 days. Tumor necrosis factor-alpha blood levels in one patient were elevated postoperatively though no signs of infection were observed. One patient died.
  
  
  CONCLUSIONS
  Although vasoplegic syndrome can complicate OPCAB surgery, the rationale for avoiding CPB remains valid considering the benefits provided by OPCAB.
authors.affiliation: Cardiovascular Surgery Discipline, Escola Paulista de Medicina and São Paulo Hospital, Federal University of São Paulo, Rua Botucatu, 740-São Paulo, SP 04023-900, Brazil. wjgomes.dcir@emp.br
authors.forename: Walter J
authors.initials: WJ
authors.lastname: Gomes
authors.forename: Manes R
authors.initials: MR
authors.lastname: Erlichman
authors.forename: Mario L
authors.initials: ML
authors.lastname: Batista-Filho
authors.forename: Marcos
authors.initials: M
authors.lastname: Knobel
authors.forename: Dirceu R
authors.initials: DR
authors.lastname: Almeida
authors.forename: Antonio C
authors.initials: AC
authors.lastname: Carvalho
authors.forename: Roberto
authors.initials: R
authors.lastname: Catani
authors.forename: Enio
authors.initials: E
authors.lastname: Buffolo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D003327:Coronary Disease / Q000601:surgery*; D005260:Female; D006801:Humans; D007022:Hypotension / Q000209:etiology*; D007249:Inflammation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality; D012189:Retrospective Studies; D015996:Survival Rate; D013577:Syndrome; D013610:Tachycardia / Q000209:etiology*; D014655:Vascular Resistance