title: Predictors of inotrope use in patients undergoing concomitant coronary artery bypass graft (CABG) and aortic valve replacement (AVR) surgeries at separation from cardiopulmonary bypass (CPB).
abstract: BACKGROUND
  Left ventricular dysfunction is common after coronary artery bypass graft and valve replacement surgeries and is often treated with inotropic drugs to maintain adequate hemodynamic status. In this study, we aimed to identify the demographic, clinical, laboratory, echocardiographic and hemodynamic factors that are associated with use of inotropic drugs in patients undergoing concomitant coronary artery bypass graft and aortic valve replacement surgery.
  
  
  METHODS
  The study included 97 patients who had undergone concomitant coronary artery bypass graft and aortic valve replacement at Regions Hospital, University of Minnesota Medical School from January 2006 to December 2008. All data were collected retrospectively after reviewing electronic medical records. Inotropic support was defined as the use of dopamine [greater than or equal to] 5 ug/kg/min; any dose of epinephrine, norepinephrine, dobutamine, and milrinone at the separation from cardiopulmonary bypass.
  
  
  RESULTS
  Inotropic support was used in a total of 50 patients (52%) at the separation from cardiopulmonary bypass. Average age of the patients requiring inotropic support was 72.2 +/- 8.8 years. The study identified four significant, independent predictors of inotrope use: (1) Cardiac index [less than or equal to] 2.5 L/min/m2, (2) LVEDP [greater than or equal to] 20 mm Hg, (3) LVEF [less than or equal to] 40%, and (4) CKD stage 3 to 5.
  
  
  CONCLUSIONS
  We identified four independent risk factors for postoperative use of inotropic support in patients undergoing concomitant coronary artery bypass graft and arotic valve replacement surgery at the separation from cardiopulmonary bypass. The study results will be helpful to prospectively identify patients who will likely to require inotropic support at the separation from cardiopulmonary bypass.
authors.affiliation: Department of Hospital Medicine, Regions Hospital, University of Minnesota Medical School, St Paul, Minnesota, USA. drimu007@gmail.com
authors.forename: Imdad
authors.initials: I
authors.lastname: Ahmed
authors.forename: Chad M
authors.initials: CM
authors.lastname: House
authors.forename: William B
authors.initials: WB
authors.lastname: Nelson
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000150:complications / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000150:complications / Q000601:surgery; D002315:Cardiopulmonary Bypass / Q000379:methods*; D002316:Cardiotonic Agents / Q000008:administration & dosage*; D001026:Coronary Artery Bypass / Q000379:methods*; D004280:Dobutamine / Q000008:administration & dosage; D004298:Dopamine / Q000008:administration & dosage; D017723:Drug Utilization Review; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000175:diagnosis; D008297:Male; D020105:Milrinone / Q000008:administration & dosage; D009638:Norepinephrine / Q000008:administration & dosage; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013318:Stroke Volume; D013566:Sympathomimetics / Q000008:administration & dosage; D016277:Ventricular Function, Left
chemical_list: D002316:Cardiotonic Agents; D013566:Sympathomimetics; D004280:Dobutamine; D020105:Milrinone; D004298:Dopamine; D009638:Norepinephrine; D004837:Epinephrine