Microvascular reactivity and clinical outcomes in cardiac surgery

Abstract

Introduction: 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).

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

Trial registration: ClinicalTrials.gov NCT01713192. Registered 22 October 2012.

Fig. 1

Study flow chart. VOT vascular occlusion test

Fig. 2

Changes in vascular occlusion test recovery slope during and after the surgery. Values are shown as mean (standard deviation). Asterisks indicate significant differences from the previous measurement (P < 0.05). Dagger indicates significant difference in recovery slope between the groups on postoperative day 1

Fig. 3

a Hospital length of stay. b Rate of composite complications stratified by tertiles of recovery slope on postoperative day 1. The boxes indicate the first quartile (bottom line), the median (central line) and the third quartile (upper line). The whiskers represent whiskers represent 10 %/90 % quantiles. Lowest tertile < 2.9 %/s, middle tertile 2.9–4.3 %/s, and highest tertile > 4.3 %/s