Abstract
Objective: to study the course of the early postoperative period depending on the profile of cardiotonic support and assess the safety of inotropic epinephrine therapy in patients operated on heart valves.
Material and methods. A retrospective cohort study involving 1421 patients operated on heart valves, divided into groups "Dobutamine" (n = 634) and "Epinephrine" (n = 787). Factors associated with the need for inotropic support with epinephrine were studied, and a comparative analysis of the concentration of markers of organ damage, the frequency and structure of organ dysfunction, and the duration of mechanical lung ventilation (MLV) was performed.
Results. The need to use epinephrine is associated with chronic heart failure 2B Vasilenko–Strazhesco (odds ratio (OR) 3.37; 95% confidenceal interval (CI) 2.43–4.67, p < 0.05), functional class (FC) IV NYHA (New-York Heart Association) (OR 1.75; 95% CI 1.38–2.22, p < 0.05), correction of mitral-tricuspid (OR 4.48; 95% CI 3.53–5.69, p < 0.05), mitral-aortic-tricuspid defect (or 3.68; 95% CI 2.26–5.99, p < 0.05) and correction mitral-aortic-tricuspid defect in combination with coronary bypass surgery (OR 5.31; 95% CI 1.19–23.61, p < 0.05). In comparison with the "Dobutamine" group, the "Epinephrine" group showed a high incidence of acute heart failure (AHF): 9.9% (78) vs. 2.2% (14) (p = 0.001), acute renal injury (ARI) – 2.4% (19) vs. 0.8% (5) (p = 0.02), cerebral disfunction (CD) – 3.7% (29) vs. 1.9% (12) (p = 0.04) and multi-organ dysfunction (MOD) – 6.0% (47) vs. 2.4% (15) (p = 0.001); 30-days mortality was 5.7% (45) in "Epinephrine" group vs. 2.1% (13) in "Dobutamine" group (p = 0.01), duration of MLV was 16 (12; 20) hours in "Epinephrine" group, vs. 14 (10; 17) hours in "Dobutamine" group (p = 0.02).
Conclusion. The need to use epinephrine occurs when correcting multi-valvular defects, including in combination with coronary bypass surgery, and is associated with increase in the duration of MLV and an increase of risk of AHF, ARI, CD, MOD and mortality.
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About the authors
- Gennadiy V. Yudin, Cand. Med. Sc., Anesthesiologist-Intensivist,
ORCID
- Andrey A. Goncharov, Anesthesiologist-Intensivist, ORCID
- Mikhail M. Rybka, Dr. Med. Sc., Head of Department of Anesthesiology,
ORCID
- Denis A. Dibin, Anesthesiologist-Intensivist, ORCID
- Dzhumber Ya. Khinchagov, Cand. Med. Sc., Anesthesiologist-Intensivist,
ORCID
- Yuris Yu. Aydashev, Anesthesiologist-Intensivist, ORCID
