IMPACT OF HEMODYNAMIC AND INFUSION THERAPY ON THE RESULTS OF MITRAL VALVE REPLACEMENT: ASPECTS AND ANALYSIS OF FACTORS
Keywords:
mitral valve insufficiency, mitral valve replacement, perioperative period, echocardiography, hemodynamics, infusion therapy, risk factorsAbstract
Objective: To study the factors associated with long-term cardiovascular support after mitral valve replacement (MVR) under artificial circulation (AC).
Material and methods: The study included patients who underwent elective cardiac surgery. Exclusion criteria were: age younger than 18 years or older than 80 years, pre-existing severe cardiac or renal dysfunction, pre-existing anemia requiring blood transfusion, chronic inflammatory diseases, long-term treatment with steroids, chronic liver disease, active infection or sepsis, emergency or repeated surgery, planned therapy with extracorporeal detoxification methods. The study included 146 patients with mitral valve insufficiency who underwent mitral valve replacement surgery at the “V.Vakhidov Republican Scientific and Practical Medical Center of Surgery”. The average age of patients was 41.1±3.0 years. The patients were predominantly male: 81 (55.5%).
Results: A total of 58 (39.7%) patients developed prolonged cardiovascular pharmacological support. These patients were older (p<0.02), had a higher EuroSCORE II (p<0.0001), more often had LVEF ≤30% (p<0.0001) and higher preoperative pulmonary hypertension (p<0.0001). Preoperative amiodarone use (p=0.007) was also more common in this group. Supported patients were more likely to experience difficulty weaning from CPB (p<0.0001), had longer aortic occlusion time (p=0.0280), CPB time (p=0.01) and anesthesia duration (p=0.01). During surgery, they received higher doses of norepinephrine (p<0.0001) and epinephrine (p=0.04). Patients with support had higher intraoperative fluid intake (p=0.0007). Lactate levels after CPB were higher (p=0.005) and hematocrit was lower (p=0.0005). In the postoperative period, the duration of mechanical ventilation (p<0.0001), ICU stay (p<0.0001) and hospital stay (p<0.0001) were longer in patients with support. A significant association was found between support and the development of acute kidney injury (p=0.049).
Conclusion: Factors associated with prolonged cardiovascular pharmacological support after MVP include higher EuroSCORE II, decreased LVEF≤30%, severe preoperative PH, preoperative amiodarone use, difficulty weaning from CPB, prolonged aortic and CPB occlusion time, high doses of norepinephrine and epinephrine during surgery, elevated lactate and low hematocrit after CPB, and positive fluid balance in the first 24 hours after surgery.
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