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J Thorac Cardiovasc Surg. 2019 Feb 13. pii: S0022-5223(19)30350-2. doi: 10.1016/j.jtcvs.2018.12.108. [Epub ahead of print]

Preoperative β-blocker use correlates with worse outcomes in patients undergoing aortic valve replacement.

Author information

1
Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Va.
2
Virginia Cardiac Services Quality Initiative, Virginia Beach, Va.
3
Inova Heart and Vascular Institute, Falls Church, Va.
4
Department of Cardiothoracic Surgery, Virginia Commonwealth University, Richmond, Va.
5
Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Va. Electronic address: gorav@virginia.edu.

Abstract

OBJECTIVES:

β-Blocker use is associated with fewer cardiac complications in patients undergoing noncardiac surgery and is a quality metric for coronary artery bypass grafting. We sought to determine the influence of preoperative β-blocker administration before aortic valve replacement (AVR).

METHODS:

All patients undergoing isolated AVR from 2002 to 2016 were extracted from a multi-institutional, statewide database composed of Society of Thoracic Surgeons data. Patients were propensity score matched by preoperative and operative variables, and the effects of preoperative β-blockers on outcomes were assessed.

RESULTS:

Of 7380 eligible patients, 53% received a preoperative β-blocker. After propensity matching, a total of 4592 patients were well matched (1:1) with minimal baseline differences between groups. Within the matched cohort, the operative mortality rate (β-blocker: 2.8% vs no β-blocker: 2.4%; P = .454) and rate of major morbidity (14.4% vs 12.7%; P = .101) were similar between groups. The rates of cardiac arrest (2.1% vs 1.3%; P = .034), renal failure requiring dialysis (1.7% vs 0.9%; P = .007), and postoperative transfusion (38.2% vs 33.8%; P = .002) after AVR were significantly greater in the cohort receiving preoperative β-blockade. Postoperative atrial fibrillation was also more prevalent in patients receiving a preoperative β-blocker (26.9% vs 23.4%; P = .007). Finally, preoperative β-blocker use was associated with longer postoperative intensive care unit stays (45.2 vs 47.0 hours; P = .001), but clinically similar hospital length of stay.

CONCLUSIONS:

Preoperative β-blocker administration is not associated with improved outcomes after AVR but instead is associated with increased postoperative morbidity. Routinely initiating preoperative β-blockade is not supported in patients undergoing AVR.

KEYWORDS:

aortic valve replacement; beta-blocker; perioperative management

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