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)

Department of Hospital Medicine, Regions Hospital, University of Minnesota Medical School, St Paul, Minnesota, USA.
Journal of Cardiothoracic Surgery (Impact Factor: 1.03). 07/2009; 4(1):24. DOI: 10.1186/1749-8090-4-24
Source: PubMed


Left ventricular dysfunction is common after coronary artery bypass graft and valve replacement surgeries and is often treated with inotropic drugs to maintain adequate hemodynamic status. In this study, we aimed to identify the demographic, clinical, laboratory, echocardiographic and hemodynamic factors that are associated with use of inotropic drugs in patients undergoing concomitant coronary artery bypass graft and aortic valve replacement surgery.
The study included 97 patients who had undergone concomitant coronary artery bypass graft and aortic valve replacement at Regions Hospital, University of Minnesota Medical School from January 2006 to December 2008. All data were collected retrospectively after reviewing electronic medical records. Inotropic support was defined as the use of dopamine [greater than or equal to] 5 ug/kg/min; any dose of epinephrine, norepinephrine, dobutamine, and milrinone at the separation from cardiopulmonary bypass.
Inotropic support was used in a total of 50 patients (52%) at the separation from cardiopulmonary bypass. Average age of the patients requiring inotropic support was 72.2 +/- 8.8 years. The study identified four significant, independent predictors of inotrope use: (1) Cardiac index [less than or equal to] 2.5 L/min/m2, (2) LVEDP [greater than or equal to] 20 mm Hg, (3) LVEF [less than or equal to] 40%, and (4) CKD stage 3 to 5.
We identified four independent risk factors for postoperative use of inotropic support in patients undergoing concomitant coronary artery bypass graft and arotic valve replacement surgery at the separation from cardiopulmonary bypass. The study results will be helpful to prospectively identify patients who will likely to require inotropic support at the separation from cardiopulmonary bypass.

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    • "In patients undergoing cardiac surgery, low cardiac output syndrome (LCOS) is a disastrous event that can result in life-threatening complications [1] [2]. With LCOS, the mortality rate of these patients can be as high as 16.9% (versus 0.9% without LCOS) [2]. "
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    • "Low cardiac output syndrome is a common complication in patients undergoing cardiac surgery [1]. The aetiology is multifactorial and is believed to be related to a combination of myocardial ischaemia, reperfusion injury, cardioplegia-induced myocardial dysfunction and preexisting cardiac disease [2]. "
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    • "Second, accelerated apoptosis of hypertrophied cardiomyocytes may further decrease mechanical cardiac efficiency and has been shown to correlate with increased release of troponin following aortic valve surgery [30,31]. Third, LV diastolic dysfunction often coexists with latent or patent alterations in systolic LV function that corresponds to the clinical syndrome of congestive heart failure and the functional states of elevated LV end-diastolic pressure or low LV ejection fraction which are all considered strong predictors of LV dysfunction, cardiac complications and mortality after cardiac surgery [2,3,5-8,32]. "
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