Factors that predict the use of positive inotropic drug support after cardiac valve surgery.
Left ventricular dysfunction is common after cardiac surgery and is often treated with positive inotropic drugs (PIDs). We hypothesized that the use of PIDs after cardiac valve surgery would have significant associations with the valvular pathophysiology and surgical procedure, and unlike the case for patients undergoing coronary artery surgery, would be unrelated to duration of cardiopulmonary bypass (CPB) or of aortic clamping. One hundred forty-nine consenting patients undergoing cardiac valve surgery were studied. Patients with hepatic or renal failure, or New York Heart Association class IV cardiac symptoms, were excluded. Patients were considered to have received PIDs if they received an infusion of amrinone, dobutamine, epinephrine, or dopamine (> or = 5 microg x kg[-1] x min[-1]). PIDs were received by 78 patients (52%). In a univariate model, older age, history of congestive heart failure, decreasing left ventricular ejection fraction, longer durations of CPB, and concurrent coronary artery surgery significantly increased the likelihood of PID support. There was also significant variation by anesthesiologist in the administration of PIDs. The specific diseased valve and valvular stenosis or insufficiency did not influence the likelihood of receiving PID support. In a multivariable model, age, history of congestive heart failure, decreasing left ventricular ejection fraction, and anesthesiologist were significantly associated with the likelihood of PID support, but duration of CPB and concurrent coronary artery surgery were not. In conclusion, patient age and ventricular function, as well as physician preferences, predicted the need for inotropic drug support; however, neither the specific valvular lesion, nor duration of CPB were strongly predictive in a multivariable model.


CONCLUSIONS
We evaluated factors related to use of positive inotropic drugs after cardiac valve surgery. The likelihood of a patient receiving these drugs increases with advancing age and with more severe preoperative left ventricular dysfunction, but was not influenced by the specific diseased valve or the duration of cardiopulmonary bypass.
Butterworth
J F
JF
Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1009, USA. jbutter@bgsm.edu
Legault
C
C
Royster
R L
RL
Hammon
J W
JW
D000676:Amrinone / Q000494:pharmacology; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D004280:Dobutamine / Q000494:pharmacology; D004311:Double-Blind Method; D004837:Epinephrine / Q000627:therapeutic use; D005260:Female; D006351:Heart Valves / Q000601:surgery*; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009200:Myocardial Contraction; D017063:Outcome Assessment, Health Care; D013997:Time Factors
D002316:Cardiotonic Agents; D004280:Dobutamine; D000676:Amrinone; D004837:Epinephrine