Cited 1 times since 2019 (2 per year) source: Scopus Journal of cardiothoracic and vascular anesthesia, Volume 33, Issue 12, 14 June 2019, Pages 3273-3280 Vasoplegia After Restrictive Mitral Annuloplasty for Functional Mitral Regurgitation in Patients With Heart Failure. van Vessem ME, Petrus AHJ, Palmen M, Braun J, Schalij MJ, Klautz RJM, Beeres SLMA

Objectives

Patients undergoing heart failure surgery are at risk for developing postoperative vasoplegia. The aim of this study was to determine the incidence, survival, and predictors of vasoplegia in heart failure patients undergoing mitral valve repair for functional mitral regurgitation and to evaluate the effect of ischemic versus non-ischemic etiology.

Design

Retrospective.

Setting

University medical center, single institutional.

Participants

Heart failure patients with functional mitral regurgitation who underwent restrictive mitral annuloplasty (2006-2015).

Measurements and main results

One hundred twenty-two patients were included (48% ischemic etiology). The incidence of vasoplegia was 19% and was not influenced by mitral regurgitation etiology. Ninety-day survival rate was decreased in vasoplegic compared with non-vasoplegic patients (65% v 93%, p < 0.001). After adjusting for age, gender, and heart failure etiology, prior hypertension (odds ratio [OR] 0.28; 95% confidence interval [CI] 0.08-0.91; p = 0.034), higher creatinine clearance (OR 0.97; 95% CI 0.95-0.99; p = 0.009), and beta-blocker use (OR 0.25; 95% CI 0.09-0.73; p = 0.011) decreased the risk of vasoplegia. Anemia (OR 3.00; 95% CI 1.10-8.20; p = 0.032) and longer cross clamp (OR 1.03; 95% CI 1.01-1.04; p = 0.001), cardiopulmonary bypass (OR 1.01; 95% CI 1.00-1.02; p = 0.003), and procedure times (OR 1.01; 95% CI 1.00-1.02, p = 0.002) increased the risk of vasoplegia.

Conclusions

Vasoplegia occurs in 19% of heart failure patients undergoing mitral valve repair for functional mitral regurgitation. It is associated with a poor early outcome. Prior hypertension, a higher creatinine clearance, and beta-blocker use were associated with a decreased risk of vasoplegia, whereas anemia and longer procedure times were associated with an increased risk of vasoplegia, independent of heart failure etiology.

Keywords: Functional Mitral Regurgitation, Vasodilatory Shock, Vasoplegia Vasoplegic Syndrome, Restrictive Mitral Annuloplasty

J Cardiothorac Vasc Anesth. 2019 Jun;33(12):3273-3280