Preoperative intraaortic balloon pumps in high-risk patients undergoing open heart surgery

Background. Reduced levels of atrial natriuretic peptide (ANP) has been suggested as a cause of fluid retention after combined Maze and valvular surgery. This study aimed to assess hormonal activation in the perioperative setting of isolated Maze procedures. Methods. Changes in ANP, brain natriuretic peptide (BNP), antidiuretic hormone (ADH), aldosterone, and angiotensin II were measured in 16 patients (mean age 53 ± 9 years) without concomitant heart disease undergoing the Maze (III) procedure. Ten matched patients (mean age 56 ± 9 years) undergoing multivessel coronary artery bypass grafting served as controls. Measurements with hemodynamic correlates were obtained at baseline and after ventricular pacing (100 stimulations/minute), directly preoperatively, postoperatively and the first postoperative day. Weight gain and diuretic requirements were recorded. Results. The major differences in hormonal response were significantly higher plasma levels of ADH (Maze preoperative 1.1 ± 0.4, postoperative 24.9 ± 16.7 pmol/L; controls preoperative 1.1 ± 0.1, postoperative 3.7 ± 3.5 pmol/L) and aldosterone (Maze preoperative 106 ± 94, postoperative 678 ± 343 pmol/L; controls preoperative 124 ± 79, postoperative 171 ± 93 pmol/L) in the Maze group on the first postoperative day (p < 0.001). Preoperative baseline plasma levels of ANP and pulmonary capillary wedge pressures (PCWP) were higher in the Maze group but this difference was abolished by pacing, and postoperatively, ANP levels changed in parallel to the PCWP in both groups. Diuretic requirements were significantly higher in the Maze group. Conclusions. Substantial increases in ADH and aldosterone were observed after the Maze procedure, indicating these hormones as important determinants in postoperative fluid retention. The role for ANP in this setting may be a less prominent than previously reported.