Microvascular reactivity and clinical outcomes in cardiac surgery.
BACKGROUND
Microvascular reactivity is decreased in patients with septic shock; this is associated with worse clinical outcomes. The objectives of the present study were to investigate microvascular reactivity in cardiac surgery patients and to assess any association with clinical outcomes.


METHODS
We retrospectively analyzed a prospectively collected registry. In total, 254 consecutive adult patients undergoing cardiac and thoracic aortic surgeries from January 2013 through May 2014 were analyzed. We performed a vascular occlusion test (VOT) by using near-infrared spectroscopy to measure microvascular reactivity. VOT was performed three times per patient: prior to the induction of anesthesia, at the end of surgery, and on postoperative day 1. The primary endpoint was a composite of major adverse complications, including death, myocardial infarction, acute kidney injury, acute respiratory distress syndrome, and persistent cardiogenic shock.


RESULTS
VOT recovery slope decreased during the surgery. VOT recovery slope on postoperative day 1 was significantly lower in patients with composite complications than those without (3.1 ± 1.6 versus 4.0 ± 1.5%/s, P = 0.001), although conventional hemodynamic values, such as cardiac output and blood pressure, did not differ between the groups. On multivariable regression and linear analyses, low VOT recovery slope on postoperative day 1 was associated with increases of composite complications (odds ratio 0.742; 95% confidence interval (CI) 0.584 to 0.943; P = 0.015) and hospital length of stay (regression coefficient (B) -1.276; 95% CI -2.440 to -0.112; P = 0.032).


CONCLUSIONS
Microvascular reactivity largely recovered on postoperative day 1 in the patients without composite complications, but this restoration was attenuated in patients with composite complications.


BACKGROUND
ClinicalTrials.gov NCT01713192. Registered 22 October 2012.
Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, 101, Daehak-Ro, Jongno-Gu, 03080, Seoul, Korea. ktkktk@gmail.com.
Tae Kyong
TK
Kim
Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, 101, Daehak-Ro, Jongno-Gu, 03080, Seoul, Korea. mingming7@gmail.com.
Youn Joung
YJ
Cho
Department of Anesthesiology and Pain Medicine, Samsung Medical Center, 81, Irwon-Ro, Gangnam-Gu, 06351, Seoul, Korea. prudence2@hanmail.net.
Jeong Jin
JJ
Min
Department of Anesthesiology and Perioperative Medicine, Schulich School of Medicine, University of Western Ontario, 4, 1465 Richmond St, N6G 2M1, London, ON, Canada. John.Murkin@lhsc.on.ca.
John M
JM
Murkin
Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, 101, Daehak-Ro, Jongno-Gu, 03080, Seoul, Korea. bahkjh@snu.ac.kr.
Jae-Hyon
JH
Bahk
Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, 101, Daehak-Ro, Jongno-Gu, 03080, Seoul, Korea. mellyn7@gmail.com.
Deok Man
DM
Hong
Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, 101, Daehak-Ro, Jongno-Gu, 03080, Seoul, Korea. jeonyunseok@gmail.com.
Yunseok
Y
Jeon
D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008833:Microcirculation / Q000502:physiology; D055806:Microvessels / Q000503:physiopathology*; D008875:Middle Aged; D059035:Perioperative Period; D011184:Postoperative Period; D012189:Retrospective Studies; D016896:Treatment Outcome