Impact of the perioperative inotropic support in grown-up congenital heart patients undergoing cardiac surgery: a propensity score adjusted analysis

Autor: Sylvie Soulie, Philippe Mauriat, Alexandre Ouattara, Nadir Tafer, Hélène Foulgoc, Mirela Bojan
Přispěvatelé: Hôpital Haut-Lévêque [CHU Bordeaux], CHU Bordeaux [Bordeaux], Université de Bordeaux (UB), Centre Chirurgical Marie Lannelongue (CCML), Université Paris-Sud - Paris 11 (UP11), Hôpital Louis Pradel [CHU - HCL], Hospices Civils de Lyon (HCL), Université de Lyon, Biologie des maladies cardiovasculaires = Biology of Cardiovascular Diseases, Université de Bordeaux (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Support was provided solely by institutional, departmental sources, or both. No external funds were obtained., INSERM, U1034
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Zdroj: Annals of Intensive Care
Annals of Intensive Care, 2020, 10 (1), pp.91. ⟨10.1186/s13613-020-00709-0⟩
Annals of Intensive Care, Vol 10, Iss 1, Pp 1-10 (2020)
ISSN: 2110-5820
DOI: 10.1186/s13613-020-00709-0⟩
Popis: Background Grown-up congenital heart (GUCH) patients represent a growing population with a high morbidity risk when undergoing reparative surgery. A main preoperative feature is right ventricular failure, which represents a risk factor for postoperative low cardiac output syndrome. Levosimendan has a potentially beneficial effect. This retrospective study included consecutive GUCH patients with surgeries in a tertiary cardiothoracic centre between 01-01-2013 and 01-10-2017, to test the hypothesis that the postoperative use of levosimendan might be associated with shorter time of mechanical ventilation, when compared with the use of milrinone. To adjust for bias related to the probability of treatment assignment, it uses the inverse propensity score weighting methodology. Results Overall 363 patients had GUCH surgeries during the study period, their mean age was 31.39 ± 15.31 years, 87 patients were eligible for analysis in the Levosimendan group and 117 in the Milrinone group. The propensity score used pre- and intraoperative variables and resulted in a good balance between covariates. The Levosimendan group included patients with higher preoperative risk scores, a higher prevalence of left and right ventricular failure, who required more often the addition of epinephrine, renal replacement therapy, prolonged mechanical ventilation and intensive care stay. However, after propensity score weighting, patients in the Levosimendan group had shorter durations of mechanical ventilation (average treatment effect − 37.59 h IQR [− 138.85 to − 19.13], p = 0.01) and intensive care stay (average treatment effect − 3.11 days IQR [− 10.03 to − 1.48], p = 0.009). The number of days of additional epinephrine support was shorter and the vasoactive inotropic scores lower. Conclusion We report a beneficial effect in terms of duration of mechanical ventilation and intensive care stay, and on inotropic requirements of the use of levosimendan following GUCH surgeries. The use of levosimendan in this setting requires validation at a larger scale.
Databáze: OpenAIRE
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