Surgical Procedure. The multi-disciplinary heart team decided on the indication and timing of surgery. SVR was performed if it was likely that a postoperative end-systolic volume index of 70 ml/m2 or less was achieved in a heart failure patient with a postinfarction left ventricular aneurysm.14 The procedure was performed according to the technique described by Dor.15 All operations were performed using cardiopulmonary bypass, aortic cross-clamping and intermittent warm blood cardioplegia. Patients received an arterial line and a pulmonary artery catheter for intra- and postoperative 4 monitoring. These data were used to calculate CI. Intraoperatively, a mean arterial pressure (MAP) ≤65 mmHg was corrected using norepinephrine. Postoperatively, norepinephrine was started if the MAP was ≤65 mmHg and the CI was normal (after adequate administration of intravascular fluids if necessary), aiming for a MAP >65mmHg and adequate end-organ perfusion. When a norepinephrine dosage >1 µg/kg/min was required, terlipressin was started. Continuous variables are expressed as mean ± standard deviation (SD) when normally distributed, or otherwise as median and interquartile range (IQR). Categorical variables are presented percentages. Missing values (NT-ProBNP baseline (N=37); thyroxine baseline (N=36); creatinine clearance 6 months (N=18), 12 months (N=19) and 24 months (N=12) follow up; NYHA 24 months (N=3) follow up; LVEF 24 months (N=3)), were replaced using multiple imputation with predictive mean matching, which was repeated a hundred times. Baseline age, gender, EuroSCORE, NYHA class, creatinine clearance and follow up data of NYHA and creatinine clearance were used as predictors in the model. The pooled data was used for analysis. Vasoplegic and non-vasoplegic patients were compared. Comparison of continuous data was performed using two-tailed unpaired Student t test for normally distributed variables or otherwise the ▇▇▇▇-▇▇▇▇▇▇▇ U test. Comparison of categorical variables was performed using the ▇▇▇▇▇▇’▇ exact test. The ▇▇▇▇▇▇ ▇▇▇▇▇ method was used to assess 6-month and 2-year mortality in vasoplegic and non-vasoplegic patients. Landmark analysis was used to assess the late effect of vasoplegia on mortality between 6 months and 2-years postoperative. Survival distributions were compared using the log-rank test. Univariable ▇▇▇ regression analysis was used to investigate the association between perioperative characteristics and 2-year mortality. The proportional hazards assumption was tested using time-dependent variables. Subsequently, all significant associations, which were not related to each other, were entered in a multivariable ▇▇▇ regression analysis to investigate the unique effect of vasoplegia on mortality after adjusting for all other relevant characteristics. To explore the effects of vasoplegia on NYHA class and LVEF at 2-year follow-up, generalized estimating equations (GEE) was performed, utilizing an independent working correlation structure. Further GEE was used to assess the effect of vasoplegia on creatinine clearance, with and without correction for baseline renal function, during 2-year follow-up. P-values <0.05 were considered statistically significant. Statistical analysis was performed using SPSS for Windows (version 21.0, Chicago, Illinois) and R (version 3.2.1, Vienna, Austria).
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Surgical Procedure. The multi-disciplinary heart team decided on the indication and timing of surgery. SVR was performed if it was likely that a postoperative end-systolic volume index of 70 ml/m2 or less was achieved in a heart failure patient with a postinfarction left ventricular aneurysm.14 The procedure was performed according to the technique described by Dor.15 All operations were performed using cardiopulmonary bypass, aortic cross-clamping and intermittent warm blood cardioplegia. Patients received an arterial line and a pulmonary artery catheter for intra- and postoperative 4 monitoring. These data were used to calculate CI. Intraoperatively, a mean arterial pressure (MAP) ≤65 mmHg was corrected using norepinephrine. Postoperatively, norepinephrine was started if the MAP was ≤65 mmHg and the CI was normal (after adequate administration of intravascular fluids if necessary), aiming for a MAP >65mmHg and adequate end-organ perfusion. When a norepinephrine dosage >1 µg/kg/min was required, terlipressin was started. Continuous variables are expressed as mean ± standard deviation (SD) when normally distributed, or otherwise as median and interquartile range (IQR). Categorical variables are presented percentages. Missing values (NT-ProBNP baseline (N=37); thyroxine baseline (N=36); creatinine clearance 6 months (N=18), 12 months (N=19) and 24 months (N=12) follow up; NYHA 24 months (N=3) follow up; LVEF 24 months (N=3)), were replaced using multiple imputation with predictive mean matching, which was repeated a hundred times. Baseline age, gender, EuroSCORE, NYHA class, creatinine clearance and follow up data of NYHA and creatinine clearance were used as predictors in the model. The pooled data was used for analysis. Vasoplegic and non-vasoplegic patients were compared. Comparison of continuous data was performed using two-tailed unpaired Student t test for normally distributed variables or otherwise the ▇▇▇▇-▇▇▇▇▇▇▇ U test. Comparison of categorical variables was performed using the ▇▇▇▇▇▇’▇ exact test. The ▇▇▇▇▇▇ ▇▇▇▇▇ method was used to assess 6-month and 2-year mortality in vasoplegic and non-vasoplegic patients. Landmark analysis was used to assess the late effect of vasoplegia on mortality between 6 months and 2-years postoperative. Survival distributions were compared using the log-rank test. Univariable ▇▇▇ regression analysis was used to investigate the association between perioperative characteristics and 2-year mortality. The proportional hazards assumption was tested using time-dependent variables. Subsequently, all significant associations, which were not related to each other, were entered in a multivariable ▇▇▇ Cox regression analysis to investigate the unique effect of vasoplegia on mortality after adjusting for all other relevant characteristics. To explore the effects of vasoplegia on NYHA class and LVEF at 2-year follow-up, generalized estimating equations (GEE) was performed, utilizing an independent working correlation structure. Further GEE was used to assess the effect of vasoplegia on creatinine clearance, with and without correction for baseline renal function, during 2-year follow-up. P-values <0.05 were considered statistically significant. Statistical analysis was performed using SPSS for Windows (version 21.0, Chicago, Illinois) and R (version 3.2.1, Vienna, Austria).
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