Improvement of outcomes after coronary artery bypass II: a randomized trial comparing intraoperative high versus customized mean arterial pressure.
OBJECTIVE
The objective of this randomized trial was to compare the efficacy of two strategies of hemodynamic management during cardiopulmonary bypass (CPB) on morbidity, mortality, cognitive complications and deterioration in functional status.


METHODS
Patients scheduled to undergo primary elective CABG were eligible. In one group, mean arterial pressure target during CPB was 80 mmHg ("high" MAP group); in the other group, MAP target was determined by patients' pre-bypass MAP ("custom" MAP group). The principal outcomes were mortality, major neurologic or cardiac complications, cognitive complications or deterioration in functional status.


RESULTS
Of 412 enrolled patients, 36% were women, with overall mean age of 64.7 +/- 12.3 years. Duration of bypass was identical for the two randomization groups. Overall complication rates were similar: 16.5% of the high group and 14.6% of the custom group experienced one or more neurologic, cardiac or cognitive complications. When only cardiac and neurologic morbidity and mortality were considered, the rates were 11.7% and 12.6%, in the high and custom groups, respectively. The aggregate outcome rate, including functional deterioration, was 31.6% in the high group and 29.6% in the custom group.


CONCLUSIONS
There were no statistically significant differences between the high MAP group and the custom MAP group for the combined outcome of mortality cardiac, neurologic or cognitive complications, and deterioration in the quality of life.
Cornell Coronary Artery Bypass Outcomes Trial Group, Department of Medicine, Weill Cornell Medical College, New York, USA. mecharl@med.cornell.edu
Mary E
ME
Charlson
Janey C
JC
Peterson
Karl H
KH
Krieger
Gregg S
GS
Hartman
James P
JP
Hollenberg
William M
WM
Briggs
Alan Z
AZ
Segal
Manish
M
Parikh
Stephen J
SJ
Thomas
Rebecca G
RG
Donahue
Mary Helen
MH
Purcell
Paul A
PA
Pirraglia
O Wayne
OW
Isom
D000368:Aged; D001794:Blood Pressure; D002315:Cardiopulmonary Bypass; D003071:Cognition; D003072:Cognition Disorders / Q000209:etiology; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003324:Coronary Artery Disease / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology; D011183:Postoperative Complications; D011184:Postoperative Period; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome