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
- Habib, G.; Erba, P.A.; Iung, B.; Donal, E.; Cosyns, B.; Laroche, C.; Popescu, B.A.; Prendergast, B.; Tornos, P.; Sadeghpour, A.; et al. Clinical presentation, aetiology and outcome of infective endocarditis. Results of the ESC-EORP EURO-ENDO (European infective endocarditis) registry: A prospective cohort study. EURO-ENDO Investigators. Eur. Heart J. 2019, 40, 3222–3232. [Google Scholar] [CrossRef] [PubMed]
- Kang, D.H.; Kim, Y.J.; Kim, S.H.; Sun, B.J.; Kim, D.H.; Yun, S.C.; Song, J.M.; Choo, S.J.; Chung, C.H.; Song, J.K.; et al. Early surgery versus conventional treatment for infective endocarditis. N. Engl. J. Med. 2012, 366, 2466–2473. [Google Scholar] [CrossRef]
- Oliver, L.; Lepeule, R.; Moussafeur, A.; Fiore, A.; Lim, P.; Ternacle, J. Early surgery in infective endocarditis: Why should we wait. Arch. Cardiovasc. Dis. 2016, 109, 651–654. [Google Scholar] [CrossRef] [PubMed]
- Habib, G.; Lancellotti, P.; Antunes, M.J.; Bongiorni, M.G.; Casalta, J.P.; Del Zotti, F.; Dulgheru, R.; El Khoury, G.; Erba, P.A.; Iung, B.; et al. 2015 ESC Guidelines for the management of infective endocarditis. Kardiol. Pol. 2015, 36, 3075–3128. [Google Scholar]
- Kortekaas, K.A.; Lindeman, J.H.; Reinders, M.E.; Palmen, M.; Klautz, R.J.; de Groot, P.G.; Roest, M. Pre-existing endothelial cell activation predicts vasoplegia after mitral valve surgery. Interact. Cardiovasc. Thorac. Surg. 2013, 17, 523–530. [Google Scholar] [CrossRef] [PubMed]
- Datt, V.; Wadhhwa, R.; Sharma, V.; Virmani, S.; Minhas, H.S.; Malik, S. Vasoplegic syndrome after cardiovascular surgery: A review of pathophysiology and outcome-oriented therapeutic management. J. Card. Surg. 2021, 36, 3749–3760. [Google Scholar] [CrossRef] [PubMed]
- Lancellotti, P.; Pibarot, P.; Chambers, J.; La Canna, G.; Pepi, M.; Dulgheru, R.; Dweck, M.; Delgado, V.; Garbi, M.; Vannan, M.A.; et al. Multi-modality imaging assessment of native valvular regurgitation: An EACVI and ESC council of valvular heart disease position paper. Scientific Document Committee of the European Association of Cardiovascular Imaging. Eur. Heart J. Cardiovasc. Imaging 2022, 23, e171–e232. [Google Scholar] [CrossRef]
- Sifaoui, I.; Oliver, L.; Tacher, V.; Fiore, A.; Lepeule, R.; Moussafeur, A.; Huguet, R.; Teiger, E.; Audureau, E.; Derbel, H.; et al. Diagnostic Performance of Transesophageal Echocardiography and Cardiac Computed Tomography in Infective Endocarditis. J. Am. Soc. Echocardiogr. 2020, 33, 1442–1453. [Google Scholar] [CrossRef]
- Fihman, V.; Faury, H.; Moussafeur, A.; Huguet, R.; Galy, A.; Gallien, S.; Lim, P.; Lepeule, R.; Woerther, P.L. Blood Cultures for the Diagnosis of Infective Endocarditis: What Is the Benefit of Prolonged Incubation? J. Clin. Med. 2021, 10, 5824. [Google Scholar] [CrossRef] [PubMed]
- Van Coile, L.; Decruyenaere, A.; Colpaert, K.; Benoit, D.; Van Vlierberghe, H.; Decruyenaere, J. Epidemiology, causes, evolution and outcome in a single-center cohort of 1116 critically ill patients with hypoxic hepatitis. Ann. Intensive Care 2018, 8, 1–13. [Google Scholar]
- Juguet, W.; Fard, D.; Faivre, L.; Koutsoukis, A.; Deguillard, C.; Mongardon, N.; Mekontso-Dessap, A.; Huguet, R.; Lim, P. Levosimendan Plus Dobutamine in Acute Decompensated Heart Failure Refractory to Dobutamine. J. Clin. Med. 2020, 9, 3605. [Google Scholar] [CrossRef] [PubMed]
- Gomes, W.J.; Carvalho, A.C.; Palma, J.H.; Goncalves, I., Jr.; Buffolo, E. Vasoplegic syndrome: A new dilemma. J. Thorac. Cardiovasc. Surg. 1994, 107, 942–943. [Google Scholar] [CrossRef] [Green Version]
- Lambden, S.; Creagh-Brown, B.C.; Hunt, J.; Summers, C.; Forni, L.G. Definitions and pathophysiology of vasoplegic shock. Crit. Care 2018, 22, 174. [Google Scholar] [CrossRef] [PubMed]
- Dayan, V.; Cal, R.; Giangrossi, F. Risk factors for vasoplegia after cardiac surgery: A meta-analysis. Interact. Cardiovasc. Thorac. Surg. 2019, 28, 838–844. [Google Scholar] [CrossRef] [PubMed]
- Ostrowski, S.; Kasielski, M.; Kordiak, J.; Zwolinska, A.; Wlodarczyk, A.; Nowak, D. Myocardial oxidative stress in patients with active infective endocarditis. Int. J. Cardiol. 2013, 167, 270–276. [Google Scholar] [CrossRef] [PubMed]
- Moris, D.; Spartalis, M.; Spartalis, E.; Karachaliou, G.S.; Karaolanis, G.I.; Tsourouflis, G.; Tsilimigras, D.I.; Tzatzaki, E.; Theocharis, S. The role of reactive oxygen species in the pathophysiology of cardiovascular diseases and the clinical significance of myocardial redox. Ann. Transl. Med. 2017, 5, 326. [Google Scholar] [CrossRef] [PubMed]
- Hobai, I.A.; Edgecomb, J.; LaBarge, K.; Colucci, W.S. Dysregulation of intracellular calcium transporters in animal models of sepsis-induced cardiomyopathy. Shock. 2015, 43, 3. [Google Scholar] [CrossRef] [PubMed]
- Kakihana, Y.; Ito, T.; Nakahara, M.; Yamaguchi, K.; Yasuda, T. Sepsis-induced myocardialdysfunction: Pathophysiology and management. J. Intensive Care 2016, 4, 22. [Google Scholar] [CrossRef] [PubMed]
- Elkhatib, W.Y.; Saunders, H.; Helgeson, S.A.; Moss, J.E. The Use of an Interleukin-6 Inhibitor in Vasoplegic Shock from Severe Systemic Inflammatory Response Syndrome: A Case Report. Indian J. Crit. Care Med. 2021, 25, 939–941. [Google Scholar] [CrossRef] [PubMed]
- Dieleman, J.M.; Nierich, A.P.; Rosseel, P.M.; van der Maaten, J.M.; Hofland, J.; Diephuis, J.C.; Schepp, R.M.; Boer, C.; Moons, K.G.; van Herwerden, L.A.; et al. Intraoperative high-dose dexamethasone for cardiac surgery: A randomized controlled trial. JAMA. 2012, 308, 1761–1767. [Google Scholar] [CrossRef] [PubMed]
- Malhotra, K.; Yerram, P. Plasmapheresis and corticosteroids in infective endocarditis-related crescentic glomerulonephritis. BMJ Case Rep. 2019, 12, e227672. [Google Scholar] [CrossRef]
- Le Moing, V.; Lacassin, F.; Delahousse, M.; Duval, X.; Longuet, P.; Leport, C.; Vildé, J.L. Use of corticosteroids in glomerulonephritis related to infective endocarditis: Three cases and review. Clin. Infect. Dis. 1999, 28, 1057–1061. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Tuckermann, J.P.; Kleiman, A.; McPherson, K.G.; Reichardt, H.M. Molecular mechanisms of glucocorticoids in the control of inflammation and lymphocyte apoptosis. Crit. Rev. Clin. Lab. Sci. 2005, 42, 71–104. [Google Scholar] [CrossRef] [PubMed]
- Siaperas, P.; Pefanis, A.; Iliopoulos, D.; Katsarolis, I.; Kyroudi-Voulgari, A.; Donta, I.; Karayiannakos, P.; Giamarellou, H. Evidence of less severe aortic valve destruction after treatment of experimental staphylococcal endocarditis with vancomycin and dexamethasone. Antimicrob. Agents Chemother. 2001, 45, 3531–3537. [Google Scholar] [CrossRef] [PubMed]
- Datzmann, T.; Träger, K. Extracorporeal membrane oxygenation and cytokine adsorption. J. Thorac. Dis. 2018, 10 (Suppl. S5), S653–S660. [Google Scholar] [CrossRef] [PubMed]
- Kofler, O.; Simbeck, M.; Tomasi, R.; Hinske, L.C.; Klotz, L.V.; Uhle, F.; Born, F.; Pichlmaier, M.; Hagl, C.; Weigand, M.A.; et al. Early Use of Methylene Blue in Vasoplegic Syndrome: A 10-Year Propensity Score-Matched Cohort Study. J. Clin. Med. 2022, 11, 1121. [Google Scholar] [CrossRef] [PubMed]
- Cho, J.S.; Song, J.W.; Na, S.; Moon, J.H.; Kwak, Y.L. Effect of a single bolus of methylene blue prophylaxis on vasopressor and transfusion requirement in infective endocarditis patients undergoing cardiac surgery. Korean J. Anesthesiol. 2012, 63, 142–148. [Google Scholar] [CrossRef] [PubMed] [Green Version]
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 |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
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