October 22, 2025Journal of Cardiothoracic Surgery1 citationsOpen Access

Effects of mannitol on cardiac function and postoperative arrhythmias after coronary artery bypass grafting: a randomized controlled trial

MMMasumeh Hemmati MaslakpakUrmia University of Technology SNSohrab NegargarTabriz University of Medical Sciences AFAli FarbodTabriz University of Medical Sciences

Structured PICO

Does mannitol added to cardiopulmonary bypass priming reduce postoperative arrhythmias and improve cardiac function in patients undergoing elective CABG?

Population

90 patients aged 18 to 70 years undergoing elective on-pump coronary artery bypass grafting (CABG) with normal kidney function (eGFR > 60 ml/min) and LVEF > 30%. Mean age 64.14, 64.4% male. Single-center (Iran).

Intervention

200 mL of mannitol 20% solution added to cardiopulmonary bypass pump prime (along with 900 mL Ringer's lactate, 50 mL sodium bicarbonate, and 5000 units sodium heparin).

Comparator

200 mL of lactated Ringer's solution added to cardiopulmonary bypass pump prime (along with 1100 mL Ringer's lactate, 50 mL sodium bicarbonate, and 5000 units sodium heparin).

Outcome

Postoperative cardiac enzyme levels (CPK, CK-MB, cTnI), incidence of arrhythmias (atrial fibrillation, ventricular fibrillation, ventricular tachycardia) up to 3 days post-surgery, and left ventricular ejection fraction on postoperative day 5.

Mannitol added to cardiopulmonary bypass priming may reduce the incidence of postoperative ventricular fibrillation in patients undergoing elective CABG, though it does not significantly affect cardiac enzyme release or LVEF.

Abstract

OBJECTIVE: Postoperative cardiac dysfunction and arrhythmias are significant complications following cardiac surgery, frequently resulting in increased mortality, longer hospital stays, higher healthcare costs, and diminished patient quality of life. This study investigates the effects of mannitol on cardiac function and the incidence of postoperative arrhythmias after coronary artery bypass grafting (CABG). METHODS: In a single-center, double-blind, randomized controlled trial, ninety patients undergoing elective on-pump CABG were randomly assigned (1:1) to receive either 200 mL of mannitol 20% (n = 45) or 200 mL of lactated Ringer's solution (n = 45) during cardiopulmonary bypass priming. Postoperative assessments included cardiac enzyme levels (creatine phosphokinase, creatine kinase-MB isoenzyme, and cardiac troponin I), incidence of arrhythmias (atrial fibrillation, ventricular fibrillation, ventricular tachycardia), and left ventricular ejection fraction. Statistical significance was defined as a p-value 0.05). Left ventricular ejection fraction was similar between the groups (45.22 ± 9.82 in the mannitol group vs. 42.66 ± 7.94 in the control group; p = 0.178). Atrial fibrillation occurred in 9 of 45 patients (20%) in the mannitol group and 12 of 45 (26.7%) in the control group (p = 0.309). Ventricular tachycardia was observed in 2 of 45 (4.4%) vs. 4 of 45 (8.9%) patients, respectively (p = 0.338). Thirty-day mortality was 2 of 45 (4.4%) in the mannitol group and 1 of 45 (2.2%) in the control group (p = 0.50). Cardiac enzyme levels (CPK, CK-MB, and cTnI) showed no significant differences between groups (p > 0.05). However, ventricular fibrillation occurred in 2 of 45 patients (4.4%) in the mannitol group versus 8 of 45 (17.8%) in the control group, a statistically significant difference (p = 0.045). CONCLUSIONS: In conclusion, while mannitol was associated with a lower incidence of ventricular fibrillation, this is a single-center study with limited power to detect differences in other outcomes. Further studies with larger sample sizes are needed to confirm these findings.

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