Intraoperative Fluid Balance and Perioperative Outcomes After Aortic Valve Surgery.

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  • Additional Information
    • Source:
      Publisher: Elsevier Country of Publication: Netherlands NLM ID: 15030100R Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1552-6259 (Electronic) Linking ISSN: 00034975 NLM ISO Abbreviation: Ann Thorac Surg Subsets: MEDLINE
    • Publication Information:
      Publication: Amsterdam : Elsevier
      Original Publication: Boston.
    • Subject Terms:
      Heart Valve Prosthesis Implantation* ; Intraoperative Care* ; Water-Electrolyte Balance*; Acute Kidney Injury/*epidemiology ; Aortic Valve Stenosis/*surgery ; Postoperative Complications/*epidemiology; Aged ; Female ; Humans ; Male ; Middle Aged ; Odds Ratio ; Retrospective Studies ; Survival Rate
    • Abstract:
      Background: The effect of intraoperative fluid balance on postoperative acute kidney injury (AKI) in cardiac surgical patients is poorly defined.
      Methods: In this retrospective study of patients undergoing aortic valve replacement for aortic stenosis, the primary outcome of interest was postoperative AKI. Secondary outcomes were postoperative fluid balance, cardiac index, vasopressor use, hospital-free days, stroke, myocardial infarction, hospital readmission, and 30- and 90-day mortality.
      Results: A total of 2327 patients were analyzed. Positive intraoperative fluid balance was associated with lower odds of AKI; the lowest odds were in the 20- to 39-mL/kg group (odds ratio, 0.56; 95% confidence interval, 0.38-0.81; P = .002). Positive intraoperative fluid balance was associated with a lower postoperative fluid balance. Increased ultrafiltration volume was associated with increased postoperative fluid resuscitation and vasopressor use. AKI was associated with increased 30- and 90-day mortality. Increased fluid balance was associated with increased odds of myocardial infarction and 30-day mortality. Increased ultrafiltration volume was associated with increased odds of 30- and 90-day mortality.
      Conclusions: In patients who underwent aortic valve replacement for aortic stenosis, positive intraoperative fluid balance was associated with decreased odds of AKI. Patients developing AKI had increased 30- and 90-day mortality. Although the overall incidence was low, increased intraoperative fluid balance was associated with myocardial infarction and 30-day mortality, whereas increased ultrafiltration volume was associated with 30- and 90-day morality. Prospective studies are needed to better define proper intraoperative fluid management in patients undergoing cardiac surgery.
      (Copyright © 2020 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
    • Comments:
      Comment in: Ann Thorac Surg. 2020 Nov;110(5):1779. (PMID: 32437673)
      Comment in: Ann Thorac Surg. 2020 Nov;110(5):1779-1780. (PMID: 32492439)
    • References:
      J Thorac Dis. 2019 Jun;11(6):2205-2207. (PMID: 31372253)
      N Engl J Med. 2018 Jun 14;378(24):2263-2274. (PMID: 29742967)
      Ann Card Anaesth. 2016 Jan-Mar;19(1):45-51. (PMID: 26750673)
      Crit Care. 2016 Jul 04;20(1):187. (PMID: 27373799)
      Curr Opin Anaesthesiol. 2017 Feb;30(1):60-65. (PMID: 27820742)
      Interact Cardiovasc Thorac Surg. 2018 Jan 1;26(1):47-53. (PMID: 29049688)
      Ann Thorac Surg. 2017 Sep;104(3):760-766. (PMID: 28434550)
      J Crit Care. 2018 Apr;44:273-277. (PMID: 29220757)
      Intensive Care Med. 2017 Jun;43(6):730-749. (PMID: 28577069)
      HSR Proc Intensive Care Cardiovasc Anesth. 2010;2(4):287-96. (PMID: 23439737)
      Perfusion. 2004 Mar;19(2):85-91. (PMID: 15162922)
      Am J Med. 2015 Apr;128(4):344-52. (PMID: 25460869)
      J Thorac Cardiovasc Surg. 2017 Jan;153(1):118-125.e1. (PMID: 27832832)
      BMC Anesthesiol. 2014 Aug 01;14:62. (PMID: 25104915)
      J Cardiothorac Vasc Anesth. 2016 Jan;30(1):69-75. (PMID: 26482483)
      Clin Colon Rectal Surg. 2019 Mar;32(2):114-120. (PMID: 30833860)
      Ann Thorac Surg. 2016 Aug;102(2):458-64. (PMID: 27344280)
      Best Pract Res Clin Anaesthesiol. 2008 Mar;22(1):193-208. (PMID: 18494397)
      Biomed Res Int. 2018 Aug 13;2018:8521893. (PMID: 30186869)
      Crit Care. 2007;11(2):R31. (PMID: 17331245)
      Interact Cardiovasc Thorac Surg. 2015 Mar;20(3):415-21. (PMID: 25424324)
      J Thorac Cardiovasc Surg. 2018 Nov;156(5):1918-1927.e2. (PMID: 29778331)
    • Grant Information:
      UL1 TR002377 United States TR NCATS NIH HHS
    • Publication Date:
      Date Created: 20200311 Date Completed: 20201113 Latest Revision: 20211002
    • Publication Date:
      20221213
    • Accession Number:
      PMC7483186
    • Accession Number:
      10.1016/j.athoracsur.2020.01.081
    • Accession Number:
      32151580