Predictors of inotrope use in patients undergoing concomitant coronary artery bypass graft (CABG) and aortic valve replacement (AVR) surgeries at separation from cardiopulmonary bypass (CPB)

Ahmed, Imdad; House, Chad M.; Nelson, W. Bradley

doi:10.1186/1749-8090-4-24

Cited by 41 publications

(35 citation statements)

References 19 publications

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“…Patients were eligible if they had undergone cardiac surgery and had persistent postoperative shock (despite preload optimization), defined as requiring high-dose catecholamines (epinephrine >0.2 µg/kg/min or norepinephrine >0.4 µg/kg/min or epinephrine + 8 (norepinephrine/2) >0.2 µg/kg/min), or cardiovascular assistance using extracorporeal membrane oxygenation/extracorporeal life support within 3-24 h following intensive care unit (ICU) admission. Exclusion criteria were: <18 years old; pregnant; previously enrolled in this or other trials evaluating mortality; on chronic hemodialysis prior to heart surgery; weight >120 kg; in a moribund state, defined as Simplified Acute Physiology Score (SAPS) II >90 (32); or those for whom active therapeutics were withheld or withdrawn.…”

Section: Patientsmentioning

confidence: 99%

Early High-Volume Hemofiltration versus Standard Care for Post–Cardiac Surgery Shock. The HEROICS Study

Combes

Bréchot

Amour³

et al. 2015

Am J Respir Crit Care Med

105

153

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For patients with post-cardiac surgery shock requiring high-dose catecholamines, the early HVHF onset for 48 hours, followed by standard volume until resolution of shock and recovery of renal function, did not lower Day-30 mortality and did not impact other important patient-centered outcomes compared with a conservative strategy with delayed CVVHDF initiation only for patients with persistent, severe acute kidney injury. Clinical trial registered with www.clinicaltrials.gov (NCT 01077349).

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Section: Patientsmentioning

confidence: 99%

Early High-Volume Hemofiltration versus Standard Care for Post–Cardiac Surgery Shock. The HEROICS Study

Combes

Bréchot

Amour³

et al. 2015

Am J Respir Crit Care Med

105

153

View full text Add to dashboard Cite

show abstract

“…Prior studies have demonstrated that an elevated LVEDP is associated with worse outcome after acute myocardial infarction (MI) [9], cardiac surgery [10,11], and left heart catheterization [12]. Furthermore, recent literature has proposed including estimates of diastolic dysfunction in future risk-stratification models in cardiac surgery [13].…”

Section: Introductionmentioning

confidence: 99%

Left ventricular end‐diastolic pressure as an independent predictor of outcome during balloon aortic valvuloplasty

Cubeddu

Don

Horvath

et al. 2013

Cathet Cardio Intervent

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Objectives In this study, we examined the predictive value of the left ventricular enddiastolic pressure (LVEDP) in patients undergoing balloon aortic valvuloplasty (BAV). Background The LVEDP is a useful indicator of hemodynamic status in patients with severe aortic stenosis. In BAV, decompensated heart failure is associated with worse outcomes. Methods We identified all consecutive patients with severe symptomatic aortic stenosis who underwent retrograde BAV at the Massachusetts General Hospital from 2004 to 2008. Patients were stratified and compared according to their baseline LVEDP into ≤15 mm Hg, 16–20 mm Hg, 21–25 mm Hg, and ≥26 mm Hg. Procedural and in-hospital outcomes and adverse events were compared. Multivariate logistic regression was used for the adjusted analysis. Results A total of 111 patients with a mean age of 83±11 years underwent BAV. Of these, the LVEDP was ≤15 mm Hg in 29 (26%), 16–20 mm Hg in 41 (37%), 21–25 mm Hg in 16 (14%), and ≥26 mm Hg in 25 (23%) patients. Baseline characteristics were similar among the four groups. Noticeably, patients with high LVEDP levels had significantly higher rates of the combined endpoint of in-hospital death, myocardial infarction (MI), cardiopulmonary arrest, and tamponade was P = 0.02. Periprocedural MI was more common among those with higher LVEDP (16% vs. 2.3%; P = 0.04). Multivariate analysis revealed LVEDP (OR 1.08, for each mm Hg increase in pressure, 95 % CI 1.02–1.14), small LV chamber size, and New York Heart Association class as independent predictors of adverse outcomes. Conclusions The LVEDP is an important independent predictor of poor in-hospital outcome during BAV. In these patients, the immediate hemodynamic status may be more important than the baseline left ventricular systolic function. Hemodynamic optimization before or during BAV should be considered and may be beneficial.

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“…Levosimendan administration seemed to be triggered in order to prevent or to immediately begin treatment of LCOS in high-risk cardiac surgery patients as these patients have the highest perioperative mortality [24]. However, when a patient received levosimendan in the first course of postoperative treatment (i.e.…”

Section: Discussionmentioning

confidence: 99%

Early administration of levosimendan is associated with improved kidney function after cardiac surgery – a retrospective analysis

Balzer

Treskatsch

Spies

et al. 2014

J Cardiothorac Surg

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BackgroundSeveral animal studies suggest beneficial effects on kidney function upon administration of levosimendan. As recent data from clinical studies are heterogeneous, we sought to investigate whether levosimendan is associated with improved postoperative kidney function in cardiac surgery patients with respect to timing of its administration.MethodsRetrospective, single centre, observational analysis at a university hospital in Berlin, Germany. All adult patients without preoperative renal dysfunction that underwent coronary artery bypass grafting and/or valve reconstruction/replacement between 01/01/2007 and 31/12/2011 were considered for analyses.ResultsOut of 1.095 included patients, 46 patients were treated with levosimendan due to a severely reduced left ventricular systolic function preoperatively (LVEF < 35%) and/or clinical signs of a low cardiac output syndrome. Sixty-one percent received the drug whilst in the OR, 39% after postoperative intensive care unit admission. When levosimendan was given immediately after anaesthesia induction, creatinine plasma levels (p = 0.009 for nonparametric analysis of longitudinal data in a two-factorial design) and incidence of postoperative renal dysfunction (67.9% vs. 94.4%; p = 0.033) were significantly reduced in contrast to a later start of treatment. In addition, duration of renal replacement therapy was significantly shorter (79 [35;332] vs. 272 [132;703] minutes; p = 0.046) in that group.ConclusionsPostoperative kidney dysfunction is a common condition in patients under going cardiac surgery. Patients with severely reduced left ventricular function and/or clinical signs of a low cardiac output syndrome who preoperatively presented with a normal kidney function may benefit from an early start of levosimendan administration, i.e. immediately after anaesthesia.Trial registrationClinicaltrials.gov-ID: NCT01918618.Electronic supplementary materialThe online version of this article (doi:10.1186/s13019-014-0167-8) contains supplementary material, which is available to authorized users.

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Predictors of inotrope use in patients undergoing concomitant coronary artery bypass graft (CABG) and aortic valve replacement (AVR) surgeries at separation from cardiopulmonary bypass (CPB)

Cited by 41 publications

References 19 publications

Early High-Volume Hemofiltration versus Standard Care for Post–Cardiac Surgery Shock. The HEROICS Study

Early High-Volume Hemofiltration versus Standard Care for Post–Cardiac Surgery Shock. The HEROICS Study

Left ventricular end‐diastolic pressure as an independent predictor of outcome during balloon aortic valvuloplasty

Early administration of levosimendan is associated with improved kidney function after cardiac surgery – a retrospective analysis

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