Impact Of Prophylactic Postoperative Vasopressors On Outcomes Of Patients Undergoing Thoracic Endovascular Aortic Repair.
Academic Article
Overview
abstract
BACKGROUND: Prophylactic postoperative vasopressors (PPV) are used to induce hemodynamic augmentation to prevent spinal cord ischemia (SCI) in patients undergoing thoracic endovascular aortic repair (TEVAR). However, the scientific evidence on its effectiveness and safety is limited. This study aims to investigate the safety and effectiveness of PPV in patients undergoing TEVAR in a multi-institutional real-world setting. METHODS: All TEVAR patients in the Society for Vascular Surgery (SVS) Vascular Quality Initiative (VQI) database between March 1, 2012, and January 28, 2023, were identified. Univariable and multivariable analyses were performed to assess the association between the use of PPV and the rates of postoperative 30-day mortality, Major Adverse Cardiovascular Events (MACE, defined as new onset of postoperative myocardial infarction (MI), congestive heart failure (CHF), dysrhythmias, or stroke), SCI, and other adverse events for patients undergoing TEVAR. RESULTS: Out of 25,549 reviewed patients, 11,342 underwent TEVAR, matching the study criteria, and were analyzed. 2,420 patients (21.3%) received PPV. Patients who received PPV had significantly higher rates of 30-day mortality (9.3% vs 2.1%, p<0.001), MACE (18.2% vs 7.4%, p<0.001), postoperative SCI (2.6% vs 1.3%, p<0.001), and other adverse events. After adjusting for confounders, the use of PPV was associated with significantly increased odds of 30-day mortality (OR, 3.23, 95%CI: 2.58-4.04, p<0.001), MACE (OR, 2.18, 95%CI: 1.89-2.51, p<0.001), postoperative SCI (OR, 1.46, 95%CI: 1.05-2.01, p=0.022) and other adverse events. CONCLUSIONS: PPV was associated with significantly higher odds of 30-day mortality, MACE, SCI, and other adverse outcomes. The role of PPV should be re-evaluated, and the decision for administration should be made on an individualized basis, considering patient comorbidities and risk factors. A prospective study is required to confirm these findings.
