Usefulness of Myocardial Injury Parameters in Predicting Prolonged Postoperative Use of Inotropes Drugs in Patients Undergoing Heart Valve Surgery

Abstract

Background: Prolonged use of inotropes drugs in the early postoperative period is one of the most common complications occurring in patients undergoing heart valve surgery. Patients requiring prolonged support via inotropes drugs are significantly more likely to experience serious postoperative complications such as acute kidney injury, cardiogenic shock, multiple organ dysfunction syndrome, and death. This study assessed the usefulness of selected perioperative parameters in predicting prolonged postoperative use of inotropic drugs and cardiogenic shock and/or death in a group of patients requiring prolonged supply of inotropes drugs. Methods: This prospective study was conducted on a group of 607 patients undergoing heart valve surgery. The primary endpoint in-hospital follow-up was prolonged postoperative use of inotropes drugs. The secondary composite endpoint was cardiogenic shock requiring mechanical circulatory support (MCS) and/or death from any cause in patients with prolonged postoperative use of inotropes drugs. Results: A total of 210 patients required inotropes drugs for more than 48 h. Age (p = 0.03), preoperative atrial fibrillation (p < 0.001), preoperative NT-proBNP level (p < 0.001), Troponin T measured one day after surgery (TnT II) (p < 0.001), and the need for urgent postoperative rethoracotomy (p < 0.001) remained independent predictors of primary endpoint. Preoperative hemoglobin level (p = 0.001) and TnT II (p < 0.001) were independent predictors of death and cardiogenic shock requiring MCS. Conclusions: Patients with elevated preoperative NT-proBNP values, as well as with increasing postoperative troponin T levels, are at risk of prolonged postoperative use of inotropes drugs, a complication which is associated with a significant risk of developing further adverse consequences, such as cardiogenic shock and death.

Keywords: N-terminal of the prohormone brain natriuretic peptide (NT-proBNP); Troponin T; heart valve surgery; low cardiac output syndrome; prolonged postoperative use of inotropes drugs.

Figure 1

Receiver operating characteristic (ROC) curves for age, preoperative NT-proBNP level and Troponin T measured on the 1st postoperative day (TnT II) for the occurrence of the primary endpoint.

Figure 2

Receiver operating characteristic (ROC) curves for preoperative hemoglobin level (Hgb) and Troponin T measured on the 1st postoperative day (TnT II) for the occurrence of the secondary endpoint.