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. 2024 Sep 26;13(19):5736.
doi: 10.3390/jcm13195736.

Relationship between Preoperative Red Cell Distribution Width and Prolonged Postoperative Use of Catecholamines in Minimally Invasive Mitral Valve Surgery Patients: A Retrospective Cohort Study

Alfonso Carrara  1 , Lorenzo Peluso  1   2 , Federica Baccanelli  1 , Matteo Parrinello  1 , Giuseppe Santarpino  3   4 , Laura Giroletti  5 , Ascanio Graniero  5 , Alfonso Agnino  5 , Giovanni Albano  1
Affiliations

Relationship between Preoperative Red Cell Distribution Width and Prolonged Postoperative Use of Catecholamines in Minimally Invasive Mitral Valve Surgery Patients: A Retrospective Cohort Study

Alfonso Carrara et al. J Clin Med. .

Abstract

Background/Objectives: Elevated RDW has emerged in cardiac surgery as a potential means of preoperative risk stratification with the capacity to predict short- and long-term postoperative mortality, acute kidney injury, and postoperative atrial fibrillation. The question as to whether perioperative hemodynamic instability may be predicted by such a marker remains a topic of ongoing debate. The aim of this study was to explore the relationship between preoperative RDW and prolonged postoperative catecholamine use in minimally invasive mitral valve surgery. Methods: We performed a retrospective monocentric cohort study in an academic hospital; we enrolled patients who had undergone minimally invasive mitral valve surgery (including both robot-assisted and non-robot-assisted procedures) between January 2019 and December 2022. We considered the use of inotropes and/or vasopressors for at least twelve hours after post-surgery ICU admission to qualify as the prolonged postoperative use of catecholamines (PPUC). The RDW was obtained from the routine full blood count analysis performed upon admission or a maximum of 72 h before surgery. We also performed a multivariable logistic regression analysis with PPUC as the dependent variable. Results: We finally enrolled 343 patients. Upon multivariate analysis, RDW >14.4% was independently associated with prolonged postoperative catecholamine use when compared to the reference group (OR 2.62 [1.06-4.84]; p = 0.03). Moreover, the EuroSCORE II score (OR 1.38 [1.03-1.85]; p = 0.03), the cross-clamp time (OR 1.01 [1.01-1.02]; p < 0.01), and robot-assisted mitral valve surgery (OR 0.53 [0.30-0.93]; p < 0.03) were independently associated with the prolonged postoperative use of catecholamines. Conclusions: This study identified that an elevated preoperative RDW (>14.4%), the EuroSCORE II score, and the cross-clamp time independently predict prolonged postoperative catecholamine use in minimally invasive mitral valve surgery patients. Conversely, the robot-assisted approach was associated with a smaller hemodynamic impairment.

Keywords: RDW; cardiac surgery; robotic surgery.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Figure 1
Figure 1
Robot-assisted procedure setting.
Figure 2
Figure 2
Non-robot-assisted procedure setting.
Figure 3
Figure 3
Differences in preoperative RDW in patients with prolonged postoperative use of catecholamines (PPUC) vs. patients without prolonged postoperative use of catecholamines (NPPUC).
Figure 4
Figure 4
Quartile distribution of preoperative RDW in patients with prolonged postoperative use of catecholamines (PPUC) vs. patients without prolonged postoperative use of catecholamines (NPPUC).
See this image and copyright information in PMC

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