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

• Published in: Journal of cardiothoracic and vascular anesthesia 2018-12, Vol.32 (6), p.2528-2536
• Main Authors: Belletti, Alessandro, Jacobs, Stephan, Affronti, Giovanni, Mladenow, Alexander, Landoni, Giovanni, Falk, Volkmar, Schoenrath, Felix
• Format: Article
• Language: English
• Subjects: Cardiac Output, Low - epidemiology; Cardiac Output, Low - physiopathology; Cardiac Output, Low - prevention & control; cardiac surgery; Cardiotonic Agents - administration & dosage; Dose-Response Relationship, Drug; Endocarditis - surgery; Female; Follow-Up Studies; Germany - epidemiology; hemodynamic support; Hemodynamics - drug effects; Hemodynamics - physiology; Humans; Incidence; infective endocarditis; inotropes; Intensive Care Units; low cardiac output syndrome; Male; Middle Aged; mortality; Postoperative Care - methods; Postoperative Complications - epidemiology; Postoperative Complications - prevention & control; Retrospective Studies; Survival Rate - trends; Time Factors
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1053/j.jvca.2017.12.015

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. Retrospective study. Tertiary-care hospital. Ninety consecutive patients undergoing cardiac surgery for infective endocarditis. None. 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