Vasoplegia after implantation of a continuous flow left ventricular assist device: incidence, outcomes and predictors

Autor: Marnix M. van der Schoot, Eric E. C. de Waal, Bas van Zaane, Albert Huisman, Wilton A. van Klei, F. Ramjankhan, Nandor Marczin
Rok vydání: 2018
Předmět:
Adult
Male
medicine.medical_specialty
medicine.medical_treatment
Cardiac index
Renal function
030204 cardiovascular system & hematology
lcsh:RD78.3-87.3
Cohort Studies
03 medical and health sciences
Postoperative Complications
0302 clinical medicine
Mechanical circulatory support
Internal medicine
Anesthesiology
Vasoplegia
medicine
Humans
Hospital Mortality
Cardiac Surgical Procedures
Mortality
Retrospective Studies
Outcome
business.industry
Incidence
Length of Stay
Middle Aged
Cardiac surgery
Intensive Care Units
Logistic Models
Treatment Outcome
Anesthesiology and Pain Medicine
medicine.anatomical_structure
030228 respiratory system
lcsh:Anesthesiology
Cardiothoracic surgery
Cardiac Vasoplegia syndrome
Ventricular assist device
Cardiology
Vascular resistance
Female
Vascular Resistance
Heart-Assist Devices
Morbidity
Prediction
business
Research Article
Zdroj: BMC Anesthesiology
BMC Anesthesiology, Vol 18, Iss 1, Pp 1-12 (2018)
ISSN: 1471-2253
DOI: 10.1186/s12871-018-0645-y
Popis: Background Vasoplegia after routine cardiac surgery is associated with severe postoperative complications and increased mortality. It is also prevalent in patients undergoing implantation of pulsatile flow left ventricular assist devices (LVAD). However, less is known regarding vasoplegia after implantation of newer generations of continuous flow LVADs (cfLVAD). We aim to report the incidence, impact on outcome and predictors of vasoplegia in these patients. Methods Adult patients scheduled for primary cfLVAD implantation were enrolled into a derivation cohort (n = 118, 2006–2013) and a temporal validation cohort (n = 73, 2014–2016). Vasoplegia was defined taking into consideration low mean arterial pressure and/or low systemic vascular resistance, preserved cardiac index and high vasopressor support. Vasoplegia was considered after bypass and the first 48 h of ICU stay lasting at least three consecutive hours. This concept of vasoplegia was compared to older definitions reported in the literature in terms of the incidence of postoperative vasoplegia and its association with adverse outcomes. Logistic regression was used to identify independent predictors. Their ability to discriminate patients with vasoplegia was quantified by the area under the receiver operating characteristic curve (AUC). Results The incidence of vasoplegia was 33.1% using the unified definition of vasoplegia. Vasoplegia was associated with increased ICU length-of-stay (10.5 [6.9–20.8] vs 6.1 [4.6–10.4] p = 0.002), increased ICU-mortality (OR 5.8, 95% CI 1.9–18.2) and one-year-mortality (OR 3.9, 95% CI 1.5–10.2), and a higher incidence of renal failure (OR 4.3, 95% CI 1.8–10.4). Multivariable analysis identified previous cardiothoracic surgery, preoperative dopamine administration, preoperative bilirubin levels and preoperative creatinine clearance as independent preoperative predictors of vasoplegia. The resultant prediction model exhibited a good discriminative ability (AUC 0.80, 95% CI 0.71–0.89, p
Databáze: OpenAIRE
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