• Marieke E van Vessem, Petrus Annelieke H J AHJ Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, the Netherlands., Meindert Palmen, Jerry Braun, Martin J Schalij, Klautz Robert J M RJM Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, the Netherlands., and Beeres Saskia L M A SLMA Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands. Electronic address: s.l.m.a.beeres@lumc.nl..
• Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, the Netherlands.
• J. Cardiothorac. Vasc. Anesth. 2019 Dec 1; 33 (12): 3273-3280.

ObjectivesPatients undergoing heart failure surgery are at risk for developing postoperative vasoplegia. The aim of this study was to determine the incidence, survival, and predictors of vasoplegia in heart failure patients undergoing mitral valve repair for functional mitral regurgitation and to evaluate the effect of ischemic versus non-ischemic etiology.DesignRetrospective.SettingUniversity medical center, single institutional.ParticipantsHeart failure patients with functional mitral regurgitation who underwent restrictive mitral annuloplasty (2006-2015).Measurements And Main ResultsOne hundred twenty-two patients were included (48% ischemic etiology). The incidence of vasoplegia was 19% and was not influenced by mitral regurgitation etiology. Ninety-day survival rate was decreased in vasoplegic compared with non-vasoplegic patients (65% v 93%, p < 0.001). After adjusting for age, gender, and heart failure etiology, prior hypertension (odds ratio [OR] 0.28; 95% confidence interval [CI] 0.08-0.91; p = 0.034), higher creatinine clearance (OR 0.97; 95% CI 0.95-0.99; p = 0.009), and beta-blocker use (OR 0.25; 95% CI 0.09-0.73; p = 0.011) decreased the risk of vasoplegia. Anemia (OR 3.00; 95% CI 1.10-8.20; p = 0.032) and longer cross clamp (OR 1.03; 95% CI 1.01-1.04; p = 0.001), cardiopulmonary bypass (OR 1.01; 95% CI 1.00-1.02; p = 0.003), and procedure times (OR 1.01; 95% CI 1.00-1.02, p = 0.002) increased the risk of vasoplegia.ConclusionsVasoplegia occurs in 19% of heart failure patients undergoing mitral valve repair for functional mitral regurgitation. It is associated with a poor early outcome. Prior hypertension, a higher creatinine clearance, and beta-blocker use were associated with a decreased risk of vasoplegia, whereas anemia and longer procedure times were associated with an increased risk of vasoplegia, independent of heart failure etiology.Copyright © 2019 Elsevier Inc. All rights reserved.

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