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Plasma Renin Activity Increases with Cardiopulmonary Bypass and is Associated with Vasoplegia following Cardiac Surgery

Published:November 21, 2022DOI:https://doi.org/10.1053/j.jvca.2022.11.019

      Abstract

      Objectives

      : To describe the trend in plasma renin activity over time in patients undergoing cardiac surgery on cardiopulmonary bypass and to investigate if increased plasma renin activity is associated with post-cardiopulmonary bypass vasoplegia.

      Design

      : A prospective cohort study.

      Setting

      : Patients were enrolled from June 2020 to May 2021 at a tertiary cardiac surgical institution.

      Patients

      : A cohort of 100 adult patients undergoing cardiac surgery on cardiopulmonary bypass.

      Interventions

      : None.

      Measurements and Main Results

      : Plasma renin activity was measured at five time points: baseline, postoperatively, and at midnight on postoperative days one, two, and three. Plasma renin activity and delta plasma renin activity were correlated with the incidence of vasoplegia and clinical outcomes. Median plasma renin activity increased approximately three times from baseline immediately following cardiac surgery, remained elevated on postoperative days zero, one and two, and began to downtrend on postoperative day three. Plasma renin activity was approximately three times higher at all measured time points in patients who developed vasoplegia versus those who did not.

      Conclusions

      : In patients undergoing cardiac surgery on cardiopulmonary bypass, plasma renin activity increases postoperatively and remains elevated through postoperative day two. Additionally, patients with vasoplegic syndrome following cardiac surgery on cardiopulmonary bypass had more robust elevations in plasma renin activity than non-vasoplegic patients. These findings support the need for randomized controlled trials to determine if patients undergoing cardiac surgery with high plasma renin activity may benefit from targeted treatment with therapies such as synthetic angiotensin II.

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