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44357 - PARSONNET SCORE AND VASOACTIVE DRUGS IN CARDIAC SURGERY

¹ Montreal Heart Institute & Université de Montréal, Montreal, QC, Canada
² Montreal Heart Institute and Université de Montréal
³ Montreal Heart Institute and Université de Montréal
⁴ Montreal Heart Institute and Université de Montréal
⁵ Montreal Heart Institute Coordinating Center
⁶ Montreal Heart Institute and Université de Montréal
⁷ Montreal Heart Institute and Université de Montréal
⁸ Montreal Heart Institute Coordinating Center

Abstract

INTRODUCTION: The Parsonnet score is a preoperative predictor of mortality in cardiac surgery (1). Mortality has been also linked to difficult separation from cardiopulmonary bypass (DSB) (2). However the link between DSB and the Parsonnet score is unknown. In addition, the severity of DSB is a continuum and correlates with the number of vasoactive agents used in that period. Therefore, our hypothesis is that there would be an association between the Parsonnet score, the number of drugs required to be weaned from CPB (or to leave the operating room as in off-pump surgery) and postoperative outcome.

METHODS: The Montreal Heart Institute (MHI) maintains a database of all their patients having surgery. Consecutive patients were recruited following informed consent. Variables including the Parsonnet score, surgical procedures, duration of CPB, and the number of vasoactive drugs required to wean were studied. The Parsonnet score and the number of vasoactive drugs were then correlated with a previously validated dichotomous composite index based on the presence of at least one of the following hemodynamic complications: new intra-aortic balloon pump (IABP) insertion after CPB, vasoactive agents for more than 24 hours postoperatively, death and cardiac arrest). The duration of hospital stay was also noted and corrected for mortality.

RESULTS: A total of 191 patients (135 males, 56 females) with a mean age of 66±11 years (mean±SD) were recruited. The procedures (including those combined) were 118 coronary artery bypass graft (CABG), 19 off-pump CABG, 51 aortic valve replacements, 20 mitral valve repairs and 13 replacements, 9 aortic surgeries and 22 miscellaneous procedures. From these, 48 were complex procedures (valve and CABG or double valve) and 14 patients were reoperations. The mean Parsonnet score was 15.8±11.6. It increased from 9.5±7.3, 13.9±9.7, 18.9±9.9, 23.5±11.3 and 40.7±25.5 in patients requiring 0 (n=12), 1 (n=129), 2 (n=37), 3 (n=7) and 4 or more (n=6) vasoactive drugs to be weaned from CPB respectively. The Parsonnet score and the number of vasoactive drugs correlated together (r=0.34; p<0.0001) and both were associated with the composite index (Parsonnet score OR: 2.0 CI 1.1–3.7 p=0.0160; drugs OR: 1.8 CI:1.2–2.9 p=0.0095) present in 39 patients (20%) (13 deaths, 9 new IABP and 34 vasoactive agents >24 hours). Both variables were associated with the duration of hospitalization (p=0.0005 and 0.0069).

CONCLUSION: There is an association between the preoperative Parsonnet score and the number of drugs required at the end of surgery. The number of drugs can be use to quantify the severity of DSB. This observation supports the association between the severity of DSB and postoperative outcomes. Prevention of DSB could potentially be proposed as a strategy to improve postoperative outcome.

REFERENCES

1) Ann Thorac Surg 2000;823.

2) J Thorac Cardiovasc Surg 2006;331.