Methylene Blue Does Not Improve Vasoplegia After Left Ventricular Assist Device Implantation
| Autor: | Joseph Sanchez, Melana Yuzefpolskaya, Amit Saha, Yoshifumi Naka, Douglas L. Jennings, Hiroo Takayama, Paolo C. Colombo, Koji Takeda, Paul Kurlansky, Andrea N. Miltiades, Jessica L. Spellman, Yuming Ning |
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| Rok vydání: | 2021 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine Mean arterial pressure medicine.medical_treatment Hemodynamics 030204 cardiovascular system & hematology 03 medical and health sciences Postoperative Complications 0302 clinical medicine Interquartile range Vasoplegia medicine Humans Enzyme Inhibitors Propensity Score Aged Retrospective Studies Heart Failure Cardiopulmonary Bypass business.industry Central venous pressure Middle Aged Confidence interval Methylene Blue 030228 respiratory system Ventricular assist device Anesthesia Female Surgery Heart-Assist Devices Cardiology and Cardiovascular Medicine Complication business Follow-Up Studies |
| Zdroj: | The Annals of Thoracic Surgery. 111:800-808 |
| ISSN: | 0003-4975 |
| DOI: | 10.1016/j.athoracsur.2020.05.172 |
| Popis: | Background Vasoplegia is a frequent complication of left ventricular assist device (LVAD) implantation. We investigated the effectiveness of methylene blue (MB) for vasoplegia in LVAD recipients. Methods Twenty-seven patients received MB for vasoplegia after LVAD implantation and met study criteria between March 2015 and May 2018. Propensity score inverse probability weighting identified 41 controls who did not receive MB for post-LVAD vasoplegia. Clinical outcomes were compared between control and MB groups and between patients who received doses during (n = 15) and after surgery (n = 12). Hemodynamics and vasopressor requirements were analyzed using analysis of covariance. Results Median total MB dose was 1.9 mg/kg (interquartile range, 1.2-2.2 mg/kg). Methylene blue recipients experienced a transient initial decline in norepinephrine requirement from 141 ng/kg per min (95% confidence interval [CI], 81-201 ng/kg per min) to 117 ng/kg per min (95% CI, 58-176 ng/kg per min; P = .022) and a delayed decline in vasopressin from 4.8 U/h (95% CI, 3.8-5.8 U/h) to 4.0 U/h (95% CI, 2.8-5.1 U/h) (P = .004). In-hospital mortality, postoperative complications, and end-organ dysfunction did not differ from those of controls. There were no observed differences in mean arterial pressure, vasopressor requirements, or outcomes between patients who received doses during or after surgery. Weighted overall mortality in the entire study cohort was 8.8%. Conclusions Although MB may affect vasopressor requirements, clinical outcomes in vasoplegia after LVAD implantation did not improve and were not affected by the timing of administration. |
| Databáze: | OpenAIRE |
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