Incidence and Predictors of Postoperative Need for High-Dose Inotropic Support in Patients Undergoing Cardiac Surgery for Infective Endocarditis

Alessandro Belletti, S Jacobs, G Affronti, A Mladenow, G Landoni, V Falk, F Schoenrath

Research output: Contribution to journalArticle

Abstract

Objective: Patients with infective endocarditis undergoing cardiac surgery are a high-risk population. Few data on incidence and predictors of need for high-dose inotropic support in this setting are currently available. Design: Retrospective study. Setting: Tertiary-care hospital. Participants: Ninety consecutive patients undergoing cardiac surgery for infective endocarditis. Interventions: None. Measurements and Main Results: Baseline, intraoperative and outcome data were collected. Stepwise multiple logistic regression analysis was performed to identify preoperative predictors of postoperative hemodynamic support. High-dose postoperative inotropic support was defined as inotropic score > 10 (calculated as dobutamine dose (in μg/kg/min) + dopamine dose (in μg/kg/min) + (epinephrine dose [in μg/kg/min] × 100) + (norepinephrine dose [in μg/kg/min] × 100) + (milrinone dose [in μg/kg/min] × 10) + (vasopressin dose [in U/kg/min] × 10 000) + (levosimendan dose [in μg/kg/min] × 50) or need for mechanical circulatory support at intensive care unit admission.Postoperative high-dose inotropic or mechanical circulatory support was required in 57 cases (61%). Stepwise multiple logistic regression identified 5 variables independently associated with need for postoperative circulatory support: male sex (odds ratio [OR] = 10.9), surgery duration (OR for every minute increase = 1.01), impairment of kidney function (eGFR <60 mL/min/m 2 - OR = 19), preoperative new-onset heart failure (defined by clinical, imaging and laboratory parameters - OR = 5.30), and low preoperative platelet count (for every 1×10 3 /μl increase - OR = 0.99). Conclusions: Patients undergoing cardiac surgery for infective endocarditis are at high risk for postoperative hemodynamic instability. Preoperative organ failure is an important determinant for postoperative hemodynamic instability. © 2017 Elsevier Inc.
Original languageEnglish
Pages (from-to)2528-2536
Number of pages9
JournalJournal of Cardiothoracic and Vascular Anesthesia
Volume32
Issue number6
DOIs
Publication statusPublished - 2018

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