Vasoplegic Syndrome after Cardiac Surgery for Infective Endocarditis
Abstract
:1. Introduction
2. Methods
2.1. Population Study
2.2. Statistical Analysis
3. Results
3.1. Patients
3.2. Cardiac Surgery
3.3. Vasoplegic Syndrome
4. Discussion
5. Limitations
6. Perspectives
7. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
References
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All (n = 166) | No Vasoplegia (n = 113) | Vasoplegic Syndrome (n = 53) | p | |
---|---|---|---|---|
Age, years | 64 ± 14 | 62 ± 15 | 69 ± 14 | 0.005 |
Gender, M | 128 (77.1) | 88 (77.8) | 40 (75.5) | 0.73 |
History of stroke, n (%) | 5 (3) | 2 (1.8) | 3 (5.7) | 0.17 |
BMI, kg/m2 | 26 ± 6 | 26 ± 6 | 25 ± 9 | 0.87 |
Hypertension, n (%) | 90 (54.2) | 58 (51.3) | 32 (60.4) | 0.27 |
Atrial fibrillation, n (%) | 34 (20.5) | 21 (18.6) | 13 (24.5) | 0.38 |
Diabete mellitus, n (%) | 43 (25.9) | 28 (24.8) | 15 (28.3) | 0.63 |
History of heart failure, n (%) | 12 (7.2) | 6 (5.3) | 6 (11.3) | 0.16 |
Coronary artery disease, n (%) | 29 (17.5) | 19 (16.8) | 10 (18.9) | 0.75 |
History of endocarditis, n (%) | 16 (9.6) | 12 (10.6) | 4 (7.5) | 0.53 |
History of cardiac surgery, n (%) | 65 (39.2) | 32 (28.3) | 33 (41.5) | 0.09 |
Cirrhosis, n (%) | 5 (3.0) | 4 (3.5) | 1 (1.9) | 0.56 |
COPD, n (%) | 6 (3.6) | 2 (1.8) | 4 (7.5) | 0.06 |
Dialysis, n (%) | 3 (1.8) | 2 (1.8) | 0 (0.0) | 0.20 |
EuroSCORE II (%) | 9.8 ± 3.6 | 8.7 ± 3.2 | 10.6 ± 3.2 | 0.0006 |
All (n = 166) | No Vasoplegia (n = 113) | Vasoplegic Syndrome (n = 53) | p | |
---|---|---|---|---|
Doc Sepsis (n = 53) | ||||
Fever, n (%) | 126 (76.0) | 86 (76.1) | 40 (75.5) | 0.93 |
Congestive heart failure, n (%) | 53 (31.9) | 33 (29.2) | 20 (37.7) | 0.27 |
Arterial embolism, n (%) | 76 (45.6) | 52 (46.0) | 24 (45.3) | 0.85 |
Ischemic stroke, n (%) | 69 (41.6) | 49 (43.4) | 20 (37.7) | 0.49 |
Hemorragic stroke, n (%) | 32 (19.2) | 24 (21.2) | 8 (15.1) | 0.35 |
Positive hemoculture, n (%) | 159 (95.8) | 107 (94.7) | 52 (98.1) | 0.30 |
Staphy aureus, n (%) | 36 (21.7) | 24 (21.2) | 12 (22.6) | 0.84 |
Staphy epidermidis, n (%) | 18 (10.8) | 9 (8.0) | 9 (7.5) | 0.93 |
Streptococcus spp, n (%) | 65 (39.9) | 45 (39.8) | 20 (37.7) | 0.80 |
Enterococcus spp., n (%) | 23 (13.8) | 14 (12.4) | 9 (17.0) | 0.71 |
Bartonella spp., n (%) | 6 (3.6) | 3 (2.7) | 3 (5.7) | 0.33 |
C-Reactive Protein, mg/mL | 74 (38–117) | 74 (33–115) | 74 (45–130) | 0.11 |
Uremia, mmol/L | 7.9 ± 5.5 | 7.3 ± 5.5 | 9.0 ± 5.5 | 0.07 |
Creat Clear, mL/min/1.73 m2 | 76 ± 31 | 79 ± 31 | 68 ± 8 | 0.02 |
NT-proBNP, pg/mL | 2240 (1021–4379) | 1998 (845–3319) | 3788 (1868–8928) | 0.0005 |
Troponin I, ng/L | 37 (15–103) | 28 (14–64) | 68 (24–208) | 0.001 |
Total bilirubin, μmol/L | 10 (7–17) | 10 (7–15) | 10 (7–15) | 0.85 |
Arterial lactate, mmol/L | 1.2 (1.2–1.2) | 1.2 (1.2–1.2) | 1.2 (1.2–1.2) | 0.85 |
Albumin, g/L | 28 ± 6 | 29 ± 6 | 27 ± 5 | 0.005 |
Echocardiograpy Data | ||||
Vegetation, n (%) | 137 (82.5) | 95 (84.1) | 42 (79.2) | 0.44 |
Vegetation size, mm (n = 163) | 15 ± 6 | 14 ± 5 | 16 ± 6 | 0.14 |
Abcess, n (%) | 47 (28.3) | 25 (22.1) | 22 (41.5) | 0.01 |
Severe MR, n (%) | 39 (23.6) | 26 (23.2) | 13 (24.5) | 0.85 |
Severe AR, n (%) | 49 (29.5) | 33 (29.2) | 18 (30.2) | 0.45 |
Severe TR, n (%) | 14 (8.4) | 8 (7.1) | 6 (11.3) | 0.36 |
LVEF, % | 57 ± 8 | 58 ± 7 | 55 ± 8 | 0.05 |
TAPSE < 15 mm, n (%) | 16 (9.6) | 7 (6.2) | 9 (17.0) | 0.03 |
CT and PET data | ||||
Abcess by CT, n (%) | 24 (14.4) | 11 (9.7) | 13 (24.5) | 0.01 |
PET fixation (n = 36), n (%) | 27 (69.4) | 16 (66.7) | 11 (91.7) | 0.11 |
IE status before surgery | ||||
Definite, n (%) | 147 (89.0) | 98 (86.7) | 50 (94.3) | 0.14 |
Prothesis IE, n (%) | 51 (30.7) | 30 (26.5) | 21 (39.6) | 0.09 |
Lead IE, n (%) | 12 (2.0) | 3 (5.3) | 6 (11.3) | 0.16 |
Native valve IE, n (%) | 115 (69.3) | 82 (72.6) | 33 (62.3) | 0.18 |
Mitrale valve IE, n (%) | 78 (47.0) | 54 (47.8) | 24 (45.3) | 0.76 |
Aortic valve IE, n (%) | 102 (61.4) | 65 (57.5) | 37 (69.8) | 0.13 |
Tricuspide IE, n (%) | 9 (5.4) | 6 (5.3) | 3 (5.7) | 0.93 |
Multivalvular, n (%) | 26 (15.7) | 17 (14.2) | 10 (18.9) | 0.44 |
All (n = 166) | No Vasoplegia (n = 113) | Vasoplegic Syndrome (n = 53) | p | |
---|---|---|---|---|
Adapted anti-biotherapy | 120 (72.3) | 83 (73.5) | 37 (69.8) | 0.63 |
Antibiotic starting to surgery, days | 7 (5–12) | 7 (5–12) | 8 (5–14) | 0.45 |
Negative BC to surgery, days | 4 (1–9) | 4 (2–9) | 4 (1–9) | 0.93 |
Cardioplegia duration, min | 133 (95–184) | 121 (89–164) | 169 (122–237) | 0.001 |
CPB duration, min | 106 (74–143) | 97 (72–130) | 126 (86–164) | 0.01 |
Valve replacement, n (%) | 133 (80.1) | 86 (76.1) | 47 (88.7) | 0.06 |
Aortic valve surgery, n (%) | 107 (64.3) | 68 (60.0) | 39 (73.6) | 0.10 |
Mitral valve surgery, n (%) | 79 (47.5) | 53 (46.8) | 26 (49.1) | 0.79 |
Tricuspid valve surgery, n (%) | 32 (19.2) | 15 (13.3) | 17 (32.1) | 0.006 |
Multivalve surgery, n (%) | 43 (25.9) | 23 (20.3) | 20 (37.7) | 0.02 |
Lead extraction, n (%) | 18 (9.3) | 9 (8.3) | 9 (9.4) | 0.80 |
Positive valve culture (n = 112), n (%) | 51 (45.5) | 32 (43.2) | 19 (50) | 0.50 |
Blood red cell unit, n | 2.0 (0.0–3.0) | 2.0 (0.0–2.0) | 2.0 (2.0–5.0) | 0.0003 |
Platelet unit, n | 0.0 (0.0–1.0) | 0.0 (0.0–0.0) | 0.0 (0.0–1.0) | 0.04 |
Fresh Frozen Plasma, n | 0.0 (0.0–3.0) | 0.0 (0.0–2.0) | 0.0 (0.0–4.0) | 0.22 |
Intensive care data | ||||
SOFA score | 8.2 ± 2.6 | 7.9 ± 2.6 | 8.9 ± 2.7 | 0.03 |
Renal replacement therapy, n (%) | 29 (17.5) | 15 (13.3) | 14 (26.4) | 0.04 |
Mechanical ventilation, days | 0 (0–2) | 0 (0,1) | 2 (1–8) | 0.03 |
Hypoxic hepatitis (n = 164), n (%) | 21 (12.8) | 5 (4.4) | 16 (31.4) | <0.001 |
Hemisuccinate, n (%) | 6 (3.6) | 0 (0) | 6 (11.3) | 0.002 |
Noradrenaline, mg/h | 0.7 (0.2–3.0) | 0.4 (0.1–0.8) | 4.9 (2.0–15.0) | <0.0001 |
Dobutamine, µg/kg/min | 0.0 (0.0–5.0) | 0.0 (0.0–0.0) | 5.0 (0.0–7.3) | 0.003 |
ECMO support, n (%) | 12 (7.4) | 2 (1.8) | 10 (19.6) | 0.0002 |
Scvo2, % (n = 138) | 68 ± 11 | 67 ± 12 | 71 ± 9 | 0.06 |
RAP > 10 mmHg, n = 164 | 45 (27.5) | 21 (18.8) | 24 (46.2) | 0.0002 |
Arterial lactate, mmol/L | 1.4 (1.1–2.0) | 1.3 (1.1–1.6) | 1.9 (1.2–3.8) | <0.0001 |
C-Reactive Protein, mg/mL | 78 (51–126) | 82 (58–127) | 65 (47–115) | 0.11 |
Re-intervention | 26 (15.8) | 7 (6.2) | 19 (36.5) | <0.0001 |
Tamponnade or bleeding, n (%) | 31 (19) | 9 (8.0) | 32 (44.0) | <0.0001 |
Valve dysfunction, n (%) | 6 (3.6) | 4 (3.5) | 2 (4.0) | 0.88 |
Mediastinitis, n (%) | 6 (3.6) | 2 (1.8) | 4 (7.8) | 0.06 |
In hospital death, n (%) | 23 (13.8) | 3 (2.6) | 20 (37.7) | <0.0001 |
Variables | OR (95% CI) | p |
---|---|---|
Preoperative NT-proBNP (per tertile) | 2.11 (1.35–3.30) | 0.001 |
CPB duration (per tertile) | 1.82 (1.16–2.88) | 0.009 |
Tricuspid surgery | 2.17 (0.91–5.19) | 0.08 |
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Lim, P.; Le Maistre, M.; Campanini, L.B.; De Roux, Q.; Mongardon, N.; Landon, V.; Bouguerra, H.; Aouate, D.; Woerther, P.-L.; Vincent, F.; et al. Vasoplegic Syndrome after Cardiac Surgery for Infective Endocarditis. J. Clin. Med. 2022, 11, 5523. https://doi.org/10.3390/jcm11195523
Lim P, Le Maistre M, Campanini LB, De Roux Q, Mongardon N, Landon V, Bouguerra H, Aouate D, Woerther P-L, Vincent F, et al. Vasoplegic Syndrome after Cardiac Surgery for Infective Endocarditis. Journal of Clinical Medicine. 2022; 11(19):5523. https://doi.org/10.3390/jcm11195523
Chicago/Turabian StyleLim, Pascal, Margaux Le Maistre, Lucas Benoudiba Campanini, Quentin De Roux, Nicolas Mongardon, Valentin Landon, Hassina Bouguerra, David Aouate, Paul-Louis Woerther, Fihman Vincent, and et al. 2022. "Vasoplegic Syndrome after Cardiac Surgery for Infective Endocarditis" Journal of Clinical Medicine 11, no. 19: 5523. https://doi.org/10.3390/jcm11195523
APA StyleLim, P., Le Maistre, M., Campanini, L. B., De Roux, Q., Mongardon, N., Landon, V., Bouguerra, H., Aouate, D., Woerther, P. -L., Vincent, F., Galy, A., Tacher, V., Galien, S., Ennezat, P. -V., Fiore, A., Folliguet, T., Huguet, R., Mekontso-Dessap, A., Iung, B., & Lepeule, R. (2022). Vasoplegic Syndrome after Cardiac Surgery for Infective Endocarditis. Journal of Clinical Medicine, 11(19), 5523. https://doi.org/10.3390/jcm11195523