Optimizing Mitral Valve Replacement Outcomes: The Role of Goal-Directed Hemodynamic and Fluid Therapy in the Perioperative Period
Background: There is no doubt that hemodynamic monitoring plays a crucial role in cardiac surgery. Research is generally aimed to identify optimal strategies for maintaining hemodynamic stability, reducing complications, and minimizing recovery time after surgery.Objective: To study the effect of ec...
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Scientific Research Institute, Ochapovsky Regional Clinical Hospital no. 1
2025-02-01
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| Series: | Инновационная медицина Кубани |
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| Online Access: | https://www.innovmedkub.ru/jour/article/view/1059 |
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| author | Ravshan A. Ibadov Sherzod M. Aliev Sardor Kh. Ibragimov Suhrob P. Ergashev |
| author_facet | Ravshan A. Ibadov Sherzod M. Aliev Sardor Kh. Ibragimov Suhrob P. Ergashev |
| author_sort | Ravshan A. Ibadov |
| collection | DOAJ |
| description | Background: There is no doubt that hemodynamic monitoring plays a crucial role in cardiac surgery. Research is generally aimed to identify optimal strategies for maintaining hemodynamic stability, reducing complications, and minimizing recovery time after surgery.Objective: To study the effect of echocardiography-guided goal-directed hemodynamic and fluid therapy on perioperative outcomes of mitral valve replacement (MVR).Material and methods: We analyzed data from 146 patients with mitral regurgitation who underwent MVR. The patients were grouped by standard hemodynamic therapy (comparison group, n=74) and goal-directed therapy (main group, n=72). The study groups were representative, and preoperative clinical, laboratory, and imaging data did not differ significantly between the groups. The study period began with the induction of general anesthesia and ended with hemodynamic stabilization achieved. This point of clinical recovery was defined as the successful extubation and absence of vasoactive support; the dose of inotropes and/or vasopressors was either completely weaned off or remained unchanged for >8 hours.Results: The study groups differed in several key parameters. The anesthesia time decreased from 255 to 223 minutes (P=.02), and the cardiopulmonary bypass time from 94 to 82 minutes (P<.001). The volume of fluids until hemodynamic stabilization was achieved was higher in the comparison group (P=.002). Inotropes were used more often in the comparison group (P><.05). The mechanical ventilation time in the main group and the comparison group was 7.33 and 13 hours, respectively (P><.001); the intensive care unit length of stay was 1.1 and 1.8 hours (P=.014), respectively. The incidence of acute myocardial ischemia was lower in the main group (2.8% vs 12.2%, P=.026). Conclusions: Goal-directed hemodynamic and fluid therapy significantly improves MVR outcomes and reduces the risk of postoperative complications and long-term use of cardiovascular drugs.> <.001) . The volume of fluids until hemodynamic stabilization was achieved was higher in the comparison group (P=.002). Inotropes were used more often in the comparison group (P <.05) ). The mechanical ventilation time in the main group and the comparison group was 7.33 and 13 hours, respectively (P <.001) ; the intensive care unit length of stay was 1.1 and 1.8 hours (P=.014), respectively. The incidence of acute myocardial ischemia was lower in the main group (2.8% vs 12.2%, P=.026).Conclusions: Goal-directed hemodynamic and fluid therapy significantly improves MVR outcomes and reduces the risk of postoperative complications and long-term use of cardiovascular drugs. |
| format | Article |
| id | doaj-art-37b9f58df9c249a4b86d1286686c6aa3 |
| institution | Kabale University |
| issn | 2541-9897 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Scientific Research Institute, Ochapovsky Regional Clinical Hospital no. 1 |
| record_format | Article |
| series | Инновационная медицина Кубани |
| spelling | doaj-art-37b9f58df9c249a4b86d1286686c6aa32025-08-20T03:47:32ZengScientific Research Institute, Ochapovsky Regional Clinical Hospital no. 1Инновационная медицина Кубани2541-98972025-02-0110171610.35401/2541-9897-2025-10-1-7-16542Optimizing Mitral Valve Replacement Outcomes: The Role of Goal-Directed Hemodynamic and Fluid Therapy in the Perioperative PeriodRavshan A. Ibadov0Sherzod M. Aliev1Sardor Kh. Ibragimov2Suhrob P. Ergashev3Republican Specialized Scientific and Practical Medical Center for Surgery named after Academician V. VakhidovRepublican Specialized Scientific and Practical Medical Center for Surgery named after Academician V. VakhidovRepublican Specialized Scientific and Practical Medical Center for Surgery named after Academician V. VakhidovRepublican Specialized Scientific and Practical Medical Center for Surgery named after Academician V. VakhidovBackground: There is no doubt that hemodynamic monitoring plays a crucial role in cardiac surgery. Research is generally aimed to identify optimal strategies for maintaining hemodynamic stability, reducing complications, and minimizing recovery time after surgery.Objective: To study the effect of echocardiography-guided goal-directed hemodynamic and fluid therapy on perioperative outcomes of mitral valve replacement (MVR).Material and methods: We analyzed data from 146 patients with mitral regurgitation who underwent MVR. The patients were grouped by standard hemodynamic therapy (comparison group, n=74) and goal-directed therapy (main group, n=72). The study groups were representative, and preoperative clinical, laboratory, and imaging data did not differ significantly between the groups. The study period began with the induction of general anesthesia and ended with hemodynamic stabilization achieved. This point of clinical recovery was defined as the successful extubation and absence of vasoactive support; the dose of inotropes and/or vasopressors was either completely weaned off or remained unchanged for >8 hours.Results: The study groups differed in several key parameters. The anesthesia time decreased from 255 to 223 minutes (P=.02), and the cardiopulmonary bypass time from 94 to 82 minutes (P<.001). The volume of fluids until hemodynamic stabilization was achieved was higher in the comparison group (P=.002). Inotropes were used more often in the comparison group (P><.05). The mechanical ventilation time in the main group and the comparison group was 7.33 and 13 hours, respectively (P><.001); the intensive care unit length of stay was 1.1 and 1.8 hours (P=.014), respectively. The incidence of acute myocardial ischemia was lower in the main group (2.8% vs 12.2%, P=.026). Conclusions: Goal-directed hemodynamic and fluid therapy significantly improves MVR outcomes and reduces the risk of postoperative complications and long-term use of cardiovascular drugs.> <.001) . The volume of fluids until hemodynamic stabilization was achieved was higher in the comparison group (P=.002). Inotropes were used more often in the comparison group (P <.05) ). The mechanical ventilation time in the main group and the comparison group was 7.33 and 13 hours, respectively (P <.001) ; the intensive care unit length of stay was 1.1 and 1.8 hours (P=.014), respectively. The incidence of acute myocardial ischemia was lower in the main group (2.8% vs 12.2%, P=.026).Conclusions: Goal-directed hemodynamic and fluid therapy significantly improves MVR outcomes and reduces the risk of postoperative complications and long-term use of cardiovascular drugs.https://www.innovmedkub.ru/jour/article/view/1059mitral regurgitationmitral valve replacementgoal-directed hemodynamic and fluid therapyintraoperative and early postoperative outcomes |
| spellingShingle | Ravshan A. Ibadov Sherzod M. Aliev Sardor Kh. Ibragimov Suhrob P. Ergashev Optimizing Mitral Valve Replacement Outcomes: The Role of Goal-Directed Hemodynamic and Fluid Therapy in the Perioperative Period Инновационная медицина Кубани mitral regurgitation mitral valve replacement goal-directed hemodynamic and fluid therapy intraoperative and early postoperative outcomes |
| title | Optimizing Mitral Valve Replacement Outcomes: The Role of Goal-Directed Hemodynamic and Fluid Therapy in the Perioperative Period |
| title_full | Optimizing Mitral Valve Replacement Outcomes: The Role of Goal-Directed Hemodynamic and Fluid Therapy in the Perioperative Period |
| title_fullStr | Optimizing Mitral Valve Replacement Outcomes: The Role of Goal-Directed Hemodynamic and Fluid Therapy in the Perioperative Period |
| title_full_unstemmed | Optimizing Mitral Valve Replacement Outcomes: The Role of Goal-Directed Hemodynamic and Fluid Therapy in the Perioperative Period |
| title_short | Optimizing Mitral Valve Replacement Outcomes: The Role of Goal-Directed Hemodynamic and Fluid Therapy in the Perioperative Period |
| title_sort | optimizing mitral valve replacement outcomes the role of goal directed hemodynamic and fluid therapy in the perioperative period |
| topic | mitral regurgitation mitral valve replacement goal-directed hemodynamic and fluid therapy intraoperative and early postoperative outcomes |
| url | https://www.innovmedkub.ru/jour/article/view/1059 |
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