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J Thorac Cardiovasc Surg 2003;126:1095-1100
© 2003 The American Association for Thoracic Surgery

Cardiopulmonary support and physiology

The effect of the maze procedure on the secretion of arginine-vasopressin and aldosterone

^a Department of Thoracic and Cardiovascular Surgery, Georgetown University Medical Center, Washington, DC, USA
^b Division of Endocrinology and Metabolism, Georgetown University Medical Center, Washington, DC, USA

Received for publication July 14, 2002; revisions received August 22, 2002; revisions received February 23, 2003; accepted for publication April 21, 2003.

^* Address for reprints: Niv Ad, MD, Cardiothoracic Surgery Department, Hadassah University Hospital, Jerusalem 91120, Israel
nivadmd{at}hotmail.com

BACKGROUND: Excessive fluid retention is a serious complication after the maze procedure that cannot be totally explained by changes in levels of atrial natriuretic peptide. We therefore measured circulating levels of arginine vasopressin and aldosterone in patients undergoing the maze procedure to study their possible role in this postoperative complication.

METHODS: Serial arginine vasopressin and aldosterone levels were monitored for 72 hours in 11 patients after coronary artery bypass grafting and in 13 patients after the maze procedure. Hemodynamic data, urine output, fluid balance, and complications were recorded prospectively during the same period of time.

RESULTS: Plasma levels of arginine vasopressin and aldosterone were significantly higher in patients after the maze procedure when compared with patients after coronary artery bypass grafting.

CONCLUSIONS: This study documents that the maze procedure results in increased plasma arginine vasopressin and aldosterone levels and indicates that they, rather than atrial natriuretic peptide alone, participate in the excessive postoperative fluid retention that follows the maze procedure. We believe that these hormone elevations are most likely secondary to a temporary lack of response of the atrial baroreceptors. These results may explain the effectiveness of spironolactone therapy after the maze procedure.