Post-operative epicardial pacing and hemodynamic support among Aortic Valve Patients
AuthorBrady, Barbara Anne
AdvisorStorr, Carla L.
MetadataShow full item record
AbstractBackground: Burdens of cardiac and extra-cardiac co-morbidity, coupled with complex surgical and anesthesia interventions, require intense intra- and post-operative monitoring and care to optimize outcomes. Despite a need for clinical guidance, a paucity of studies explores post-operative temporary epicardial pacing, vasopressor and inotropic medication use among aortic valve replacement (AVR) patients. Purpose: To better target post-operative interventions for AVR patients, associations between pre and intra-operative risk factors (e.g., chronic conditions, QRS duration and medication use), cardiovascular interventions (pacing and hemodynamic support), and post-operative outcomes (morbidity and resource utilization) were explored. Methods: Medical records of 195 patients having an AVR from 11/2007 to 10/2011 were reviewed from a single academic medical center. Cross-sectional analyses used multivariable analyses to identify factors associated with temporary epicardial pacing, acute kidney injury, and length of stay. Results: Patients were equally represented in gender, nearly all (88%) Caucasian, with a mean age of 67.7 years (SD=12.9). More than a third of patients (36%) were paced at time of bypass separation; 13% of the total continued to be paced after 7 a.m. of post-operative day-1. Females were more likely to be paced in the CSICU (OR = 3.08, 1.30-7.31), while pre-operative co-morbidities, ejection fraction, QRS duration, stain or ACE/ARB uses and CPB time did not have an independent effect. Post-operative pacing and level of hemodynamic support were not associated with day-2 renal function. Prolonged CSICU stays were associated with female gender, age>75 years, and if both epicardial and hemodynamic supports were used as compared to no cardiovascular support. Prolonged hospital stays were associated with prolonged CSICU stay > 4 days and age>75 years. Conclusions: Post-operative management of AVR patients has considerable variability. While it would be useful to pre-operatively identify patients requiring extended post-operative pacing and hemodynamic support, no co-morbidities were associated. Additional studies are needed to better risk stratify AVR patients so interventions can be targeted so the care team can better plan care and monitor progress.
DescriptionUniversity of Maryland, Baltimore. Nursing. Ph.D. 2013
Acute Kidney Injury
Length of Stay