Article description

Summary:

• The study aimed to describe the trend in plasma renin activity over time in patients undergoing cardiac surgery on cardiopulmonary bypass and investigate if increased plasma renin activity is associated with post-cardiopulmonary bypass vasoplegia.
• A prospective cohort study included 100 adult patients undergoing cardiac surgery using cardiopulmonary bypass at a tertiary cardiac surgical institution.
• Plasma renin activity was measured at five-time points: baseline, postoperatively, and midnight on postoperative days 1, 2, and 3.
• Plasma renin activity and delta plasma renin activity were correlated with the incidence of vasoplegia and clinical outcomes.
• The median plasma renin activity increased approximately three times from baseline immediately after cardiac surgery, remained elevated on postoperative days 0, 1, and 2, and began to downtrend on postoperative day 3.
• 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 increased postoperatively and remained elevated through postoperative day 2.
• Patients with vasoplegic syndrome after 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.