Key result
Preoperative exposure to renin-angiotensin system antagonists significantly increased the incidence of a clinically significant systolic pressure gradient (>10 mmHg) between radial and femoral arteries after cardiopulmonary bypass (69% vs 27%, p<0.001).
Why the study?
Does preoperative treatment with renin-angiotensin system antagonists increase the femoral to radial arterial pressure gradient after cardiopulmonary bypass in patients undergoing valvular heart surgery?
Cohort (n=85)
Does preoperative treatment with renin-angiotensin system antagonists increase the femoral to radial arterial pressure gradient after cardiopulmonary bypass in patients undergoing valvular heart surgery?
Preoperative use of renin-angiotensin system antagonists significantly increases the incidence of clinically relevant radial-to-femoral arterial pressure gradients after cardiopulmonary bypass in valvular heart surgery, suggesting femoral monitoring may be needed to avoid inappropriate vasopressor therapy.
Answers are grounded in this paper and cite their sources.
Preoperative renin-angiotensin system antagonist exposure was associated with higher post-bypass radial-femoral gradients; leaves open whether femoral monitoring should be adopted in valvular surgery.
Background: Femoral to radial arterial pressure gradient (P) often develops after cardiopulmonary bypass (CPB) where radial artery pressure (RAP) does not reflect the actual perfusion pressure. Renin-angiotensin system antagonists (RAS-A) are increasingly prescribed preoperatively which causes vasodilation and vascular remodeling. We evaluated the effect of RAS-A medication on P after CPB in patients undergoing valvular heart surgery.
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Kim et al. (2007) conducted a cohort in Valvular heart disease with regurgitant lesions (n=85). Preoperative Renin-Angiotensin System Antagonists (RAS-A) vs. Control group (not on RAS-A) was evaluated on Development of systolic pressure gradient (∆P) > 10 mmHg between femoral and radial artery after cardiopulmonary bypass (p=<0.001). Preoperative exposure to renin-angiotensin system antagonists significantly increased the incidence of a clinically significant systolic pressure gradient (>10 mmHg) between radial and femoral arteries after cardiopulmonary bypass (69% vs 27%, p<0.001).
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