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Ștef A, Bodolea C, Bocșan IC, Achim A, Tintiuc N, Pop RM, Solomonean AG, Manea A, Buzoianu AD. Perioperative Modulation of Left Ventricular Systolic Performance: A Retrospective Study on Ionized Calcium and Vitamin D in Cardiac Surgery Patients. J Pers Med 2024; 14:850. [PMID: 39202041 PMCID: PMC11355764 DOI: 10.3390/jpm14080850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2024] [Revised: 08/04/2024] [Accepted: 08/08/2024] [Indexed: 09/03/2024] Open
Abstract
Background: The perioperative impact of calcium and vitamin D on left ventricular (LV) performance during major cardiac surgery remains unexplored. We aimed to assess the relation of calcium and vitamin D measured at different time points with the LV ejection fraction (EF), and to investigate whether changes in EF correlate with postoperative outcomes. Methods: We enrolled 83 patients, in whom ionized calcium was measured before, during, and after surgery (until discharge), vitamin D preoperatively, and EF pre- and postoperatively at 24 h. The postoperative outcomes were cardiopulmonary bypass (CPB) time, aortic cross-clamp time, mechanical ventilation time, vasoactive inotropic score (VIS) (intraoperative, day 0, day 1), and ICU stay time. Results: The mean age was 64.9 ± 8.5 years, with 21 of the patients (25%) having an EF < 50%. The median change from preoperative to postoperative EF was -2.0 (-10.0-0.0) % (p < 0.001). At the baseline, the EF < 50% group had significantly lower preoperative vitamin D levels than the EF ≥ 50% group (p = 0.048). The calcium trend did not differ across the groups. Preoperative EF was significantly associated with CPB time (r = 0.22, p = 0.044) and aortic cross-clamp time (r = 0.24, p = 0.031). Postoperative EF was significantly and inversely associated with intraoperative VIS (r = -0.28, p = 0.009), VIS day 0 (r = -0.25, p = 0.020), VIS day 1 (r = -0.23, p = 0.036), and ICU length of stay (r = -0.22, p = 0.047). Finally, the change in ejection fraction was significantly and inversely associated with CPB time (r = -0.23, p = 0.037), aortic cross-clamp time (r = -0.22, p = 0.044), intraoperative VIS (r = -0.42, p < 0.001), VIS day 0 (r = -0.25, p = 0.024), mechanical ventilation time (r = -0.22, p = 0.047), and ICU length of stay (r = -0.23, p = 0.039). Conclusions: The fluctuations in perioperative ionized calcium levels were not associated with the evolution of LVEF, although preoperative vitamin D levels may affect those with low EF. Correspondingly, a reduced EF significantly impacted all the studied postoperative outcomes. Further investigation into biomarkers affecting cardiac inotropic function is warranted to better understand their significance.
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Affiliation(s)
- Adrian Ștef
- Clinical Department of Anesthesia and Intensive Care, Heart Institute “Niculae Stancioiu”, University of Medicine and Pharmacy “Iuliu Hatieganu”, Motilor 19-21, 400001 Cluj-Napoca, Romania
- Department of Surgery, Discipline of Anesthesia and Intensive Care 2, University of Medicine and Pharmacy “Iuliu Hatieganu”, Victor Babes Nr. 8 Street, 400012 Cluj-Napoca, Romania
- Cardiology Department, Heart Institute “Niculae Stancioiu”, University of Medicine and Pharmacy “Iuliu Hatieganu”, Motilor 19-21, 400001 Cluj-Napoca, Romania
| | - Constantin Bodolea
- Department of Surgery, Discipline of Anesthesia and Intensive Care 2, University of Medicine and Pharmacy “Iuliu Hatieganu”, Victor Babes Nr. 8 Street, 400012 Cluj-Napoca, Romania
| | - Ioana Corina Bocșan
- Department of Pharmacology, Toxicology and Clinical Pharmacology, University of Medicine and Pharmacy “Iuliu Hatieganu”, Victor Babes Nr. 8 Street, 400012 Cluj-Napoca, Romania (R.M.P.)
| | - Alexandru Achim
- Cardiology Department, Heart Institute “Niculae Stancioiu”, University of Medicine and Pharmacy “Iuliu Hatieganu”, Motilor 19-21, 400001 Cluj-Napoca, Romania
| | - Nadina Tintiuc
- Clinical Department of Anesthesia and Intensive Care, Heart Institute “Niculae Stancioiu”, University of Medicine and Pharmacy “Iuliu Hatieganu”, Motilor 19-21, 400001 Cluj-Napoca, Romania
| | - Raluca Maria Pop
- Department of Pharmacology, Toxicology and Clinical Pharmacology, University of Medicine and Pharmacy “Iuliu Hatieganu”, Victor Babes Nr. 8 Street, 400012 Cluj-Napoca, Romania (R.M.P.)
| | - Aurelia Georgeta Solomonean
- Clinical Department of Anesthesia and Intensive Care, Heart Institute “Niculae Stancioiu”, University of Medicine and Pharmacy “Iuliu Hatieganu”, Motilor 19-21, 400001 Cluj-Napoca, Romania
| | - Alexandru Manea
- Cardiovascular Surgery Department, Heart Institute “Niculae Stancioiu”, University of Medicine and Pharmacy “Iuliu Hatieganu”, Motilor 19-21, 400001 Cluj-Napoca, Romania
| | - Anca Dana Buzoianu
- Department of Pharmacology, Toxicology and Clinical Pharmacology, University of Medicine and Pharmacy “Iuliu Hatieganu”, Victor Babes Nr. 8 Street, 400012 Cluj-Napoca, Romania (R.M.P.)
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The effect of calcium gluconate administration during cardiopulmonary bypass on hemodynamic variables in infants undergoing open-heart surgery. Egypt Heart J 2022; 74:29. [PMID: 35416549 PMCID: PMC9006523 DOI: 10.1186/s43044-022-00266-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 04/05/2022] [Indexed: 11/20/2022] Open
Abstract
Background The incidence of complications after heart surgery is a critical factor in disability, deaths, lengthening hospital stays, and increasing treatment costs. The metabolic balance of certain hormones and electrolytes is necessary for proper cardiac function. In children, various biochemical conditions may cause calcium depletion during heart surgery. The purpose of this study was to determine the effect of calcium gluconate administration during cardiopulmonary bypass on hemodynamic variables and clinical outcomes in infants undergoing open-heart surgery. This study was conducted at Rajaie Cardiovascular Medical and Research Center in 2021 using a controlled randomized clinical trial. A total of 60 patients with open-heart surgery weighing up to 10 kg were included in the study. The first group received an intravenous injection of calcium gluconate 20 min after opening the aortic clamp, and the second group was monitored as a control group. Data collection tools included checklists containing demographics, surgical information, and intensive care unit measures. Results The Chi-square test or Fisher's exact test showed that the frequency distribution of gender, blood group, Rhesus factor (RH), and clinical diagnosis in the two groups of intervention and control was not statistically significant (p < 0.05). The mean and standard deviation of Ejection Fraction (EF) changes (before and after) were 13.27 ± 9.16 in the intervention group and 8.31 ± 9.80 in the control group (p = 0.065). The results of two-way repeated measures ANOVA showed that mean systolic blood pressure (p = 0.030), mean diastolic blood pressure (p = 0.021), mean heart rate (p = 0.025), mean arterial pressure (p = 0.020), mean pH (p < 0.001), and mean hemoglobin (p = 0.018) in the intervention, and control groups were statistically significant. Conclusions In the present study, unlike systolic pressure, mean diastolic blood pressure decreased, and mean arterial pressure increased significantly. As a result, the slope of changes during the study period was different in the intervention and control groups.
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