Transient Hypoparathyroidism During CPB

Robertie, P G; Butterworth, J. S.; Royster, Roger L.; Tucker, William Y.; Zaloga, Gary P.

doi:10.1097/00000542-198909001-00081

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“…It is possible that perturbations in the ionized calcium values in acutely ill patients represent an adaptive and protective response, and some data suggest that calcium administration may be harmful in critical illness. A study showed that, even though calcium levels drop during the onset of CPB, parathormone levels markedly increase and calcium levels return almost to normal before the patient emerges from the bypass [34]. On the other hand, open-heart surgery induces acute stress and acute stress is detrimental to circulating 25-hydroxyvitamin D (25(OH)D) concentration.…”

Section: Discussionmentioning

confidence: 99%

Investigating Potential Correlations between Calcium Metabolism Biomarkers and Periprocedural Clinical Events in Major Cardiovascular Surgeries: An Exploratory Study

Ștef,

Bodolea,

Bocșan

et al. 2024

JCM

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Background: There is emerging but conflicting evidence regarding the association between calcium biomarkers, more specifically ionized calcium and the prognosis of intensive care unit (ICU) postoperative cardiac patients. Methods: Our study investigated the relationship between ionized calcium, vitamin D, and periprocedural clinical events such as cardiac, neurologic and renal complications, major bleeding, vasoactive–inotropic score (VIS), and length of ICU and hospitalization. Results: Our study included 83 consecutive subjects undergoing elective major cardiac surgery requiring cardiopulmonary bypass. The mean age of the participants was 64.9 ± 8.5 years. The majority of procedures comprised isolated CABG (N = 26, 31.3%), aortic valve procedures (N = 26, 31.3%), and mitral valve procedures (N = 12, 14.5%). A difference in calcium levels across all time points (p < 0.001) was observed, with preoperative calcium being directly associated with intraoperative VIS (r = 0.26, p = 0.016). On day 1, calcium levels were inversely associated with the duration of mechanical ventilation (r = −0.30, p = 0.007) and the length of hospital stay (r = −0.22, p = 0.049). At discharge, calcium was inversely associated with length of hospital stay (r = −0.22, p = 0.044). All calcium levels tended to be lower in those who died during the 1-year follow-up (p = 0.054). Preoperative vitamin D levels were significantly higher in those who experienced AKI during hospitalization (median 17.5, IQR 14.5–17.7, versus median 15.3, IQR 15.6–20.5, p = 0.048) Conclusion: Fluctuations in calcium levels and vitamin D may be associated with the clinical course of patients undergoing cardiac surgery. In our study, hypocalcemic patients exhibited a greater severity of illness, as evidenced by elevated VIS scores, and experienced prolonged mechanical ventilation time and hospital stays. Additional larger-scale studies are required to gain a deeper understanding of their impact on cardiac performance and the process of weaning from cardiopulmonary bypass, as well as to distinguish between causal and associative relationships.

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Section: Discussionmentioning

confidence: 99%