Association between perioperative β-blocker use and clinical outcome of non-cardiac surgery in coronary revascularized patients without severe ventricular dysfunction or heart failure

Right ventricular dysfunction and failure receive much less attention than the left ventricular failure. Right ventricular dysfunction or failure is associated with increased mortality rates in cardiac surgery, surgical cases other than cardiac surgery and also in patients treated in the ICU. The purpose of this article review was to describe the anatomy, physiology and pathophysiology of right ventricular failure, its detection and diagnosis, and management considerations from anesthetic point of view, including preoperative, intraoperative and postoperative stages. Cardiac surgery may result in right ventricular failure. For example, 0.1% post cardiotomy patients experience severe right heart failure and require long-term inotropic support, and so do 2-3% of post-transplant patients, and 20-30% of patients installed with instrument in his left heart. Therefore, anesthesiologists play a major role in perioperative and postoperative intensive care and are obliged to comprehend the nature of right ventricular dysfunction and failure so as to carry out early detection, prevent and manage patients with right ventricular dysfunction.

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Autoantibodies Specifically Against β1 Adrenergic Receptors and Adverse Clinical Outcome in Patients With Chronic Systolic Heart Failure in the β-Blocker Era: The Importance of Immunoglobulin G3 Subclass

Journal of Cardiac Failure ◽

10.1016/j.cardfail.2016.03.005 ◽

2016 ◽

Vol 22 (6) ◽

pp. 417-422 ◽

Cited By ~ 10

Author(s):

Yuji Nagatomo ◽

Daniel Li ◽

Jennifer Kirsop ◽

Alan Borowski ◽

Akanksha Thakur ◽

...

Keyword(s):

Heart Failure ◽

Clinical Outcome ◽

Adrenergic Receptors ◽

Systolic Heart Failure ◽

Adverse Clinical Outcome ◽

Chronic Systolic Heart Failure ◽

Β Blocker

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Abstract 15823: Diminished Vasoresponsiveness in Patients With Heart Failure

Circulation ◽

10.1161/circ.142.suppl_3.15823 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Olga Papazisi ◽

Marieke E van Vessem ◽

Saskia L Beeres ◽

Rob B de Wilde ◽

Remco R Berendsen ◽

...

Keyword(s):

Heart Failure ◽

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Clinical Outcome ◽

Prospective Observational Study ◽

Independent Predictor ◽

Medical Center ◽

Vascular Response ◽

Patients With Heart Failure ◽

Vascular Responsiveness

Introduction: Vasoplegia is a severe complication after cardiac surgery and is associated with impaired clinical outcome. Pre-operative heart failure (HF) is considered an independent predictor of post-operative vasoplegia. We hypothesize that HF patients are more susceptible to vasoplegia due to altered vascular responsiveness. In this study, vasoresponsiveness in patients undergoing cardiac surgery for HF is investigated. Methods: A prospective, observational study was conducted at Leiden University Medical Center. We included patients with HF (N=18) and without HF (N=18) who underwent cardiac surgery on cardiopulmonary bypass. Vasoresponsiveness was assessed at 4 different timepoints: 1) before induction, 2) after induction, 3) after cessation of cardiopulmonary bypass and 4) on the first postoperative day. The vascular response was recorded as change in systemic vascular resistance (SVR) after the administration of phenylephrine (bolus 2 μg/kg). Results: Thirty-six patients were included [67 (61-71) years, 78% male]. Vascular responsiveness was significantly attenuated in patients with HF compared to controls. The response to phenylephrine was already diminished at baseline in HF patients and was almost abolished after cessation of cardiopulmonary bypass (Figure). Roughly the same pattern of vasoresponsiveness was found when excluding patients that received norepinephrine. Moreover, HF patients required a significantly higher amount of noradrenaline [169.80 (IQR 14.77-318.97) ug/kg] compared to controls [3.61 (IQR 0-41.60) ug/kg] to maintain similar SVR during the first 24h postoperatively. Conclusions: The vascular responsiveness is altered in patients with HF and this might explain the higher prevalence of vasoplegia in this patient population.

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