Early postoperative hemodynamic instability after heart transplantation – incidence and metabolic indicators
Abstract Background Primary graft dysfunction (PGD) is the main cause of death in the first 30 days after heart transplantation (HTX), accounting for approximately 40% of mortality. The study’s primary aim was to assess the incidence of PGD, following the International Society for Heart and Lung Tra...
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| Format: | Article |
| Language: | English |
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BMC
2021-10-01
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| Series: | BMC Anesthesiology |
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| Online Access: | https://doi.org/10.1186/s12871-021-01455-x |
| _version_ | 1818735784080965632 |
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| author | Anna Kędziora Jacek Piątek Hubert Hymczak Grzegorz Wasilewski Bartłomiej Guzik Rafał Drwiła Bogusław Kapelak Dorota Sobczyk Janusz Konstanty-Kalandyk Karol Wierzbicki |
| author_facet | Anna Kędziora Jacek Piątek Hubert Hymczak Grzegorz Wasilewski Bartłomiej Guzik Rafał Drwiła Bogusław Kapelak Dorota Sobczyk Janusz Konstanty-Kalandyk Karol Wierzbicki |
| author_sort | Anna Kędziora |
| collection | DOAJ |
| description | Abstract Background Primary graft dysfunction (PGD) is the main cause of death in the first 30 days after heart transplantation (HTX), accounting for approximately 40% of mortality. The study’s primary aim was to assess the incidence of PGD, following the International Society for Heart and Lung Transplantation consensus, and to compare it with the incidence of significant postoperative hypotension despite administration of high-dose inotropes and vasoconstrictors. The secondary aim of the study was to determine changes in biochemical markers that accompany the phenomenon. Methods Forty-five patients who underwent HTX between 2010 and 2015 were enrolled in this study, and detailed hemodynamic and metabolic data from the first 48 postoperative hours were collected and analyzed. Hemodynamic instability was defined as significant postoperative hypotension (mean arterial pressure (MAP) < 60 mmHg) combined with a high inotrope score (> 10). Data for long-term mortality were obtained from the population registration office. Results PGD incidence was relatively low (17.8%); however, hemodynamic instability was common (40%). Among unstable patients, MAP was insufficient for end-organ perfusion (51.4 ± 9.5 mmHg) but no decrease in left ventricular function was observed (cardiac index, 2.65 ± 0.6 l/min/m2; left ventricular ejection fraction, 52.9 ± 15.5%). Within this group, mean systemic vascular resistance index (961 ± 288 dyn*s*m2/cm5) was low despite receiving high doses of vasoactive agent (norepinephrine 0.21 (0.06-0.27) μg/kg/min during first 24 h postoperatively and 0.21 (0.01-0.27) μg/kg/min during next 24 h postoperatively). After HTX, serum lactate levels were initially significantly higher in patients with hemodynamic instability (p = 0.002); however, impaired lactate clearance was not observed (p = 0.366), and lactate levels normalized within the first 24 h postoperatively. Postoperative hemodynamic instability altered the long-term outcome and increased 5-year mortality after HTX (p = 0.034). Conclusions Hemodynamic instability is a more common phenomenon than PGD. Only early postoperative serum lactate levels correspond with hemodynamic instability following HTX. Postoperative hemodynamic instability is associated with poor long-term survival among HTX recipients. |
| first_indexed | 2024-12-18T00:26:45Z |
| format | Article |
| id | doaj.art-f8d2fae871f340c9a64fa1e302893762 |
| institution | Directory Open Access Journal |
| issn | 1471-2253 |
| language | English |
| last_indexed | 2024-12-18T00:26:45Z |
| publishDate | 2021-10-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Anesthesiology |
| spelling | doaj.art-f8d2fae871f340c9a64fa1e3028937622022-12-21T21:27:14ZengBMCBMC Anesthesiology1471-22532021-10-012111910.1186/s12871-021-01455-xEarly postoperative hemodynamic instability after heart transplantation – incidence and metabolic indicatorsAnna Kędziora0Jacek Piątek1Hubert Hymczak2Grzegorz Wasilewski3Bartłomiej Guzik4Rafał Drwiła5Bogusław Kapelak6Dorota Sobczyk7Janusz Konstanty-Kalandyk8Karol Wierzbicki9Department of Cardiovascular Surgery and Transplantology, John Paul II HospitalDepartment of Cardiovascular Surgery and Transplantology, John Paul II HospitalDepartment of Anesthesiology and Intensive Care, John Paul II HospitalDepartment of Cardiovascular Surgery and Transplantology, John Paul II HospitalJagiellonian University Medical CollegeJagiellonian University Medical CollegeDepartment of Cardiovascular Surgery and Transplantology, John Paul II HospitalJagiellonian University Medical CollegeDepartment of Cardiovascular Surgery and Transplantology, John Paul II HospitalDepartment of Cardiovascular Surgery and Transplantology, John Paul II HospitalAbstract Background Primary graft dysfunction (PGD) is the main cause of death in the first 30 days after heart transplantation (HTX), accounting for approximately 40% of mortality. The study’s primary aim was to assess the incidence of PGD, following the International Society for Heart and Lung Transplantation consensus, and to compare it with the incidence of significant postoperative hypotension despite administration of high-dose inotropes and vasoconstrictors. The secondary aim of the study was to determine changes in biochemical markers that accompany the phenomenon. Methods Forty-five patients who underwent HTX between 2010 and 2015 were enrolled in this study, and detailed hemodynamic and metabolic data from the first 48 postoperative hours were collected and analyzed. Hemodynamic instability was defined as significant postoperative hypotension (mean arterial pressure (MAP) < 60 mmHg) combined with a high inotrope score (> 10). Data for long-term mortality were obtained from the population registration office. Results PGD incidence was relatively low (17.8%); however, hemodynamic instability was common (40%). Among unstable patients, MAP was insufficient for end-organ perfusion (51.4 ± 9.5 mmHg) but no decrease in left ventricular function was observed (cardiac index, 2.65 ± 0.6 l/min/m2; left ventricular ejection fraction, 52.9 ± 15.5%). Within this group, mean systemic vascular resistance index (961 ± 288 dyn*s*m2/cm5) was low despite receiving high doses of vasoactive agent (norepinephrine 0.21 (0.06-0.27) μg/kg/min during first 24 h postoperatively and 0.21 (0.01-0.27) μg/kg/min during next 24 h postoperatively). After HTX, serum lactate levels were initially significantly higher in patients with hemodynamic instability (p = 0.002); however, impaired lactate clearance was not observed (p = 0.366), and lactate levels normalized within the first 24 h postoperatively. Postoperative hemodynamic instability altered the long-term outcome and increased 5-year mortality after HTX (p = 0.034). Conclusions Hemodynamic instability is a more common phenomenon than PGD. Only early postoperative serum lactate levels correspond with hemodynamic instability following HTX. Postoperative hemodynamic instability is associated with poor long-term survival among HTX recipients.https://doi.org/10.1186/s12871-021-01455-xHeart transplantationPrimary graft failureHemodynamic instabilitySerum lactateVasoplegiaInotrope score |
| spellingShingle | Anna Kędziora Jacek Piątek Hubert Hymczak Grzegorz Wasilewski Bartłomiej Guzik Rafał Drwiła Bogusław Kapelak Dorota Sobczyk Janusz Konstanty-Kalandyk Karol Wierzbicki Early postoperative hemodynamic instability after heart transplantation – incidence and metabolic indicators BMC Anesthesiology Heart transplantation Primary graft failure Hemodynamic instability Serum lactate Vasoplegia Inotrope score |
| title | Early postoperative hemodynamic instability after heart transplantation – incidence and metabolic indicators |
| title_full | Early postoperative hemodynamic instability after heart transplantation – incidence and metabolic indicators |
| title_fullStr | Early postoperative hemodynamic instability after heart transplantation – incidence and metabolic indicators |
| title_full_unstemmed | Early postoperative hemodynamic instability after heart transplantation – incidence and metabolic indicators |
| title_short | Early postoperative hemodynamic instability after heart transplantation – incidence and metabolic indicators |
| title_sort | early postoperative hemodynamic instability after heart transplantation incidence and metabolic indicators |
| topic | Heart transplantation Primary graft failure Hemodynamic instability Serum lactate Vasoplegia Inotrope score |
| url | https://doi.org/10.1186/s12871-021-01455-x |
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